CHARLOTTE — Home health agencies are a segment of the medical industry that you may not know about if you or a loved one has never needed one. The companies send therapists and nurses into the homes of Medicare patients to help them recover from an illness or surgery.

This summer the federal government started rating home health agencies – doling out one to five stars – to give consumers a better picture of the job  they do. The top grades were elusive: only 239 agencies out of 9,000 nationwide earned five stars, according to a Kaiser Health News analysis.

In North Carolina, Brookdale Home Health Charlotte was one of just two agencies out of more than 170 in the state to earn five stars. How did they manage it?

Physical therapist Kurt Harcar’s session with Annie Wilson is a window into Brookdale’s success.

Harcar helped Wilson to her feet and handed her a soccer ball. “You’re going to hold onto the ball, both hands,” he said. “Now we want to go side to side.”

“I was a great square dancer back in my young days,” Wilson, 105, said with a laugh.

It’s far from square dancing, but the exercise is designed to improve her balance and help her manage the walker that allows her to still get around on her own.

“The big key that we try and focus on here is making sure they’re safe and as independent as they can be,” Harcar said. The side-to-side soccer ball move can help Wilson maintain her balance as she navigates the kitchen or bathroom in her apartment.

How often patients get better at moving around is one way Brookdale sets itself apart. It’s also far above national averages on quickly initiating care and easing pain, according to Medicare data.

“These metrics as a whole show home health’s ability to improve somebody’s function and home health’s ability to prevent costly episodes that are negative for the patient, like a hospitalization or like a delay in service,” said Harrison Brown of The Advisory Board Company, a consulting firm.

That’s part of the reason Medicare is putting a brighter spotlight on home health – by keeping people out of the hospital, it can save the federal government money.

Brown said the new star ratings are good for consumers and for the most effective agencies.

“This is really an opportunity for home health agencies to differentiate themselves, given that home health actually has a lot of variability in it in terms of quality and cost,” Brown said.

The ratings have limitations. Bill Dombi of the National Association for Home Care and Hospice says that for one, they emphasize improvement.

“The population in home health tends to be fairly aged with multiple chronic illnesses, where stabilization may be the goal rather than improvement,” he said.

Dombi said it’s unrealistic for a patient with Parkinson’s disease, for example, to get much better. But home health can help that person maintain some independence.

Another limitation is that the underlying data for the star ratings are self-reported, which creates potential for some agencies to pad their stats.

“You don’t know what you’re getting, and there is little quality oversight of the data,” said Dan Mendelson, CEO of consulting firm Avalere Health.

He said the data need to improve before Medicare starts tying payments to the quality metrics, as it’s already doing with hospitals.

“Some home health agencies are taking this very seriously and are getting really good real-time data and going in and collecting the data on patients that they see, and others aren’t,” he says. “That’s the situation right now.”

Brookdale Home Health Charlotte is getting real-time data. Nurses like Ginny Grenda use tablets to update patient information as they go.

“I don’t hear near as much congestion as I did when we were listening last week,” she told patient Larry Goelz as she listened to his lungs recently.

Goelz is coming off a hospitalization for pneumonia and congestive heart failure. To help his lungs recover, she’s given him a device he can use to practice blowing.

It’s easy for Grenda to keep tabs on Goelz – she’s part of  a Brookdale team  set up inside this retirement community. “We are in the building, which helps,” she says. “We see them intermittently. But if there is a complication, the staff can get us, and we can get orders to see the patient as needed.”

Brookdale Home Health has teams set up in 22 retirement communities in the Charlotte area. That may give it an advantage in the star ratings over agencies that are constantly driving from home to home.

That said, the only other five-star agency in North Carolina, Well Care Home Health in Wilmington, mostly does serve private homes.

Brookdale’s director, Cheryl Engram, says the more important factors are how experienced her staff is and how well they know their patients. One nurse said she is as familiar with her patients as she is with her family.

“That speaks to me volumes about what we do and the services that we provide,” Engram says. “Not just the fact that we’ve got a team of people here, but that the people who make up that team are following through on the things that they need to do.”

Engram says Brookdale is now looking to expand, and it’ll use its five-star rating as a selling point.