Ask most home health administrators to list their key performance indicators (KPIs), and you’ll likely hear the usual suspects:
- Star ratings
- Hospitalization rates
- Outcome scores
- Patient satisfaction
- OASIS accuracy
- Reimbursement per episode
These are all valid — but they’re lagging indicators.
They tell you what already happened.
They tell you where you’ve been.
They do not tell you where you’re going.
And by the time you see them dip? It’s often too late to fix the underlying problem without a painful cost — in dollars, quality, or staff morale.
That’s why high-performing home health agencies are shifting toward leading indicators — real-time, actionable KPIs that predict performance before outcomes are locked in.
If you’re serious about staying ahead (not just staying afloat), these are six of the most important KPIs you should be tracking right now.
1. SOC Documentation Timeliness (Within 24 Hours)
Let’s start where care begins — with the Start of Care (SOC). It’s not just when you admit the patient, it’s when the clock starts ticking on outcomes, quality, and compliance.
But what many agencies don’t track closely is the lag time between the SOC visit and when documentation is submitted.
Why it matters:
- Delayed documentation delays QA review, which delays OASIS locking, which delays billing
- Errors go unnoticed until they’re baked into claims or quality scores
- Late documentation leads to missed interventions and unclear clinical direction
Benchmark: 90%+ of SOC documentation submitted within 24 hours of the visit
Leading indicator of: Timely reimbursement, OASIS accuracy, care coordination strength
2. Missed Visit Notification Rate
Most agencies track missed visits. Fewer track how often they’re notified about a missed visit in real time — versus learning about it at the end of the week when documentation is turned in.
Why it matters:
- Missed visits aren’t just a documentation issue — they’re a clinical and compliance red flag
- Notifying leadership promptly allows for same-day intervention and rescheduling
- Chronic no-shows may signal care plan fatigue or dissatisfaction
Benchmark: 100% of missed visits reported to the office within 2 hours
Leading indicator of: Patient satisfaction, care continuity, compliance risk mitigation
3. Visits Scheduled at Time of Referral Acceptance
How often are visits being scheduled immediately after the referral is accepted — before intake or insurance verification is even complete?
Why it matters:
- Agencies that wait to schedule until everything is “clean” lose critical hours (or days)
- Prompt scheduling at referral creates trust with referral partners and patients
- It signals operational efficiency and confidence
Benchmark: 90%+ of referrals scheduled within 2 hours of acceptance
Leading indicator of: Faster SOC, stronger referral partner retention, growth capacity
4. LUPA Risk Detection Rate at Admission
LUPAs (Low Utilization Payment Adjustments) are a lagging metric that cuts reimbursement. But the real KPI is how well your team identifies LUPA risk before it happens — ideally, at admission.
Why it matters:
- Accurate assessment of visit needs at SOC helps prevent unnecessary LUPAs
- Flags complex cases that require closer coordination
- Empowers clinicians to advocate for the right care plan from day one
Benchmark: 100% of SOCs assessed for LUPA risk with visit plan flagged for review
Leading indicator of: Episode efficiency, optimized reimbursement, PDGM alignment
5. Unlocked OASIS Rate (After 5 Days)
You already know how critical OASIS accuracy is. But here’s a better metric to watch:
How many OASIS assessments are still unlocked 5 days after the visit?
Why it matters:
- Unlocked assessments = unverified data
- Delays care coordination, slows billing, and increases compliance risk
- Indicates breakdowns in documentation workflow, supervision, or training
Benchmark: Less than 5% of OASIS assessments remain unlocked after 5 days
Leading indicator of: Data integrity, survey readiness, payment delays
6. Scheduled-but-Not-Completed Visit Rate
This KPI often lives in the blind spots of EMR reporting. You may see visits scheduled, and you may see visits documented — but do you know how many fell through the cracks in between?
Why it matters:
- A high scheduled-not-completed rate creates gaps in care and incomplete episodes
- It may point to staff overload, unclear expectations, or faulty routing
- It’s often the silent cause of missed frequencies or loss of outcomes points
Benchmark: <2% of visits scheduled but not completed without valid reason
Leading indicator of: Operational control, PDGM discipline mix accuracy, utilization integrity
The Problem with Lagging KPIs
Lagging KPIs, by nature, show up when the damage is done:
- Star ratings dropped
- Reimbursement dipped
- Audit flagged inconsistencies
- Referral partners lost confidence
But leading KPIs like the six above show up while the problem is still fixable. They allow you to course-correct in real time — which means better outcomes, stronger margins, and fewer surprises.
Think of it like driving: lagging KPIs are your rearview mirror.
Leading KPIs are your windshield.
Why Most Agencies Don’t Track These KPIs
It’s not that agencies don’t care — it’s that many:
- Rely on EMR dashboards that only surface lagging metrics
- Haven’t mapped processes tightly enough to extract early data
- Don’t have internal systems for daily KPI review or accountability
- Don’t realize these metrics exist (until someone shows them)
And that’s exactly where improvement begins.
Final Thought: What You Watch, You Improve
If your agency’s leadership meetings are still dominated by last month’s data — it’s time to evolve.
The agencies growing today (even in a squeezed, regulated, competitive market) are the ones who stop chasing lagging outcomes and start managing to leading inputs.
Your metrics should tell you what’s coming — not just what went wrong.
