November 10 2025
OASIS Answers
Categories: HHQRP

Which Quality Measures on Care Compare Are Risk Adjusted?

Why Risk Adjustment Matters for Home Health Quality Reporting

While the quality measures used in calculating the Quality of Patient Care Star Rating tend to receive the most attention, it’s equally important to understand which of all the quality measures reported on Care Compare are risk adjusted.

At OASIS Answers’ Blueprint for OASIS Accuracy workshops, we emphasize how certain OASIS items — even those that may not seem “obvious” — contribute to risk adjustment and impact public outcomes.

What Is Risk Adjustment?

The general intent of risk adjustment is to account for differences in patient case mix or risk factors when comparing outcomes across agencies.

According to Chapter 1 of the OASIS-E1 Guidance Manual:

“Risk adjustment is a statistical methodology designed to separate the relationship of outcome with care provided from the relationship to outcomes with the natural progression of disease and disability.”

In other words, it ensures that agencies caring for more complex or higher-risk patients aren’t unfairly penalized in quality comparisons.

Resources for Understanding Quality Measures

To get a comprehensive overview of the quality measures, visit the Home Health Quality Measures page on CMS.gov. These official resources provide details about which measures are risk adjusted and how they’re calculated:

📊 Outcome Measure Table (PDF)

📋 Process Measure Table (PDF)

Each table identifies the source of the data (OASIS or claims), whether the measure appears on Care Compare, and if it is risk adjusted. Note that each risk-adjusted measure uses its own model.

Risk-Adjusted Measures on Care Compare

For clarity, let’s review which measures reported on Care Compare are risk adjusted.
An asterisk (*) indicates measures also used in calculating the Quality of Patient Care Star Ratings.

Managing Daily Activities

All four measures in this category are risk adjusted:

Improvement in Ambulation-Locomotion (How often patients got better at walking or moving around)*
Improvement in Bed Transferring (How often patients got better at getting in and out of bed)*
Improvement in Bathing (How often patients got better at bathing)*
Discharge Function Score (DFS) — How often patients were at or above an expected ability to care for themselves and move around at discharge

Treating Symptoms

Both measures in this category are risk adjusted:

Improvement in Dyspnea (How often patients’ breathing improved)*
Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury (How often patients have new or worsened pressure ulcers/injuries)

Preventing Harm

Only one of the seven measures reported in this category is risk adjusted:

Improvement in Management of Oral Medications (How often patients got better at taking their drugs correctly by mouth)*

The remaining measures in this category are process-based or best-practice measures, and therefore not risk adjusted, including:

Timely Initiation of Care*
Influenza Immunization Received for Current Flu Season
Drug Regimen Review Conducted with Follow-Up
Falls with Major Injury
TOH–Patient (Medication list provided at discharge)
TOH–Subsequent Provider (Medication list sent to next healthcare setting)

Preventing Unplanned Hospital Care

All four claims-based measures in this category are risk adjusted. These rely on Medicare fee-for-service (FFS) claims, not OASIS data:

Discharge to Community (DTC-PAC) – How often patients remained in the community after discharge
Potentially Preventable 30-Day Post-Discharge Readmission (PPR)
Home Health Within-Stay Potentially Preventable Hospitalization (PPH) *
Medicare Spending Per Beneficiary (MSPB) – How much Medicare spends on an episode of care compared nationally

Why OASIS Accuracy Is More Important Than Ever

Understanding which measures are risk adjusted – and how – can help agencies interpret their public scores more accurately. Since these adjustments account for patient complexity, OASIS data accuracy directly affects your agency’s Care Compare results, Star Ratings, and overall performance under HHVBP.

By ensuring precise, consistent OASIS documentation, your agency strengthens both compliance and the credibility of its publicly reported outcomes.