Data Analysis
How good is home health care in America?
Most home health agencies in the US are average — not great, not terrible. But a small percentage stand out dramatically. We analyzed CMS Medicare data for 12,215 agencies to show you how to tell the difference.
12,215
Agencies analyzed
7,900
Have CMS star rating
65% of total
3.24 / 5
Avg star rating
78.54
Avg Atlas Score
Grade: B
What is a “good” home health agency?
CMS rates agencies on a 1-5 star scale. Here's what each rating actually means relative to the national average of 3.24.
4.5 - 5 ★
Top tier
Rare. Excellent across all measures.
Top 5%
4.0 ★
Strong
Above average. Solid outcomes.
Top 18%
3.5 ★
Above avg
Better than most. Room to improve.
Top 35%
3.0 ★
Average
Right in the middle. Meets basic standards.
Top 52%
1 - 2.5 ★
Below avg
Gaps in multiple areas.
Most agencies fall between 3.0 and 4.0. Small differences matter more than they seem.
Key findings
- 1.The national average CMS star rating is 3.24 out of 5, based on 7,900 rated agencies.
- 2.35% of Medicare-certified agencies have no CMS star rating. The Atlas Score fills this gap using underlying quality metrics.
- 3.Quality varies widely by state: NJ averages 86.3 while CO averages 70.9.
- 4.NON-PROFIT agencies score highest on average (81.9) compared to other ownership types.
- 5.Agencies offering all 6 service types average 3.29 stars vs. 2.98 for agencies offering 2 or fewer.
- 6.On average, agencies begin care in a timely manner 94.05% of the time.
Why 35% of agencies have no rating
Over one-third of Medicare-certified home health agencies don't receive a CMS star rating. That doesn't mean they're bad — it means they have insufficient reporting volume, are newer agencies, or have incomplete data submissions.
CMS leaves these agencies as a blank. HomeCareAtlas fills this gap by computing an Atlas Score from the underlying performance metrics that CMS does collect — even when there aren't enough to generate a star rating.
States with most unrated agencies
74%
DC
26 of 35
71%
OH
593 of 838
58%
MA
165 of 284
54%
PA
222 of 414
50%
CO
109 of 219
48%
DE
11 of 23
47%
TX
862 of 1849
38%
CA
1129 of 3009
37%
MN
52 of 141
35%
ND
7 of 20
How to choose a home health agency (based on the data)
We looked at what separates top-performing agencies from the rest. Here's what the data says matters most.
Look for 4.0+ stars if available
A 4.0 puts an agency in the top 18% nationally. That's meaningfully above average.
If no star rating, check the Atlas Score
35% of agencies have no stars. The Atlas Score uses the same underlying metrics to give you a grade anyway.
Prioritize functional outcomes
Walking, bathing, and medication management improvements are the strongest predictors of overall quality. Ask about these specifically.
Compare against your local average
A 3.5 in a low-scoring state may be excellent. The same score in a high-performing state may be mediocre. Context matters.
Your location matters more than you think
The average agency in CO (70.9) scores significantly lower than in NJ (86.3). This means a “3.5-star” agency in a low-scoring state may be stronger than one in a high-performing state.
Highest-scoring states
Lowest-scoring states
Agencies with more services tend to rate higher
CMS tracks six service types: nursing, physical therapy, occupational therapy, speech pathology, medical social services, and home health aide. Here's how service breadth correlates with quality.
| Services Offered | Avg Stars | Avg Atlas Score | Agencies |
|---|---|---|---|
| 0 of 6 | 2.98 ★ | 78.16B | 775 |
| 1 of 6 | 1.5 ★ | 68C+ | 5 |
| 2 of 6 | 2.73 ★ | 67.28C+ | 127 |
| 3 of 6 | 3.17 ★ | 75.08B | 213 |
| 4 of 6 | 3.16 ★ | 75.45B | 459 |
| 5 of 6 | 3.2 ★ | 76.91B | 1,222 |
| 6 of 6(full service) | 3.29 ★ | 79.52B | 6,026 |
Star rating distribution
How CMS star ratings are spread across 7,900 rated agencies.
Atlas Score grade distribution
51
1%
538
6%
2,084
24%
2,551
29%
1,414
16%
870
10%
478
5%
270
3%
125
1%
329
4%
117
1%
Only 1% of agencies earn an A+.
Quality by ownership type
Does it matter who owns the agency? Here's how ownership correlates with quality.
| Ownership Type | Avg Atlas Score | Avg Stars | Agencies |
|---|---|---|---|
| NON-PROFIT | 81.9B+ | 3.36 ★ | 981 |
| PROPRIETARY | 78.2B | 3.26 ★ | 6,843 |
| GOVERNMENT OPERATED | 76.1B | 2.83 ★ | 230 |
National metric averages
Average performance across all Medicare-certified home health agencies for each CMS quality metric.
| Metric | National Avg | Reporting | |
|---|---|---|---|
| Major Fall Prevention | 1.1% | 8,547 | |
| Walking & Mobility | 83.1% | 7,958 | |
| Bathing Independence | 85.4% | 7,968 | |
| Medication Independence | 80.8% | 7,860 | |
| Breathing & Shortness of Breath | 84.3% | 7,748 | |
| Bed Mobility | 82.9% | 7,927 | |
| Discharge Function | 61.48 | 7,991 | |
| Speed of Starting Care | 94.0% | 8,555 | |
| Health Info Shared with Doctors | 77.7% | 7,360 | |
| Health Info Shared with Patient | 90.3% | 7,594 |
How the Atlas Score works
CMS gives star ratings to 65% of Medicare-certified agencies. The rest get nothing. We built the Atlas Score to fill that gap — and to give a more complete picture even for rated agencies.
Quality of Outcomes — 40%
Did patients get better at walking, bathing, breathing, and managing medications?
Safety — 30%
How well does the agency prevent falls, hospitalizations, and readmissions?
Responsiveness — 20%
How quickly does care start? Is health info shared with doctors and patients?
Data Completeness — 10%
How many quality metrics does the agency report? More data means more accountability.
Methodology
Data source: Centers for Medicare & Medicaid Services (CMS) Home Health Compare dataset, updated from the CMS public provider data catalog.
Scope: This analysis covers Medicare-certified home health agencies only. Non-medical home care agencies that do not participate in Medicare are not included in CMS data. The Atlas Score applies only to agencies with at least one reported CMS quality metric.
Atlas Score: A composite 0-100 score computed from CMS quality metrics: functional outcomes (40%), safety (30%), responsiveness (20%), and data completeness (10%). Unlike CMS star ratings, the Atlas Score works for every agency that reports at least one quality metric — including the 35% that CMS leaves unrated.
Find top-rated agencies near you
Search our directory to see Atlas Scores, CMS quality data, and how agencies compare to state and national averages.
Researched and reviewed by
John Helmy, Founder of HomeCareAtlasBuilding tools and resources to help home care agency owners navigate licensing, compliance, and growth.