Posted on Monday, February 3, 2020 2:02 PM
The final recommendations for quality Measures Under Consideration (MUC) from the National Quality Forum (NQF) Measures Application Partnership (MAP) have been posted and they include one measure for hospice and one for home health.
The HH QRP MUC is 19-34, Home Health Within-Stay Potentially Preventable Hospitalization Measure and for hospice it was MUC19-33, Hospice Visits in the Last Days of Life. These now go to the NQF, which will make the final decision. Current quality measures in the HHQRP and the HQRP could be replaced by these new measures. The rationale for the MAPs final recommendation is below.
“Measure |
MAP Preliminary Recommendation and Rationale |
MUC19-33: Hospice Visits in the Last Days of Life |
CONDITIONAL SUPPORT FOR RULEMAKING MAP conditionally supported MUC2019-33 Hospice Visits in the Last Days of Life for rulemaking, pending NQF endorsement and removal of the existing hospice visit measures from the program. Generally, MAP agreed that collecting information about hospice staff visits will encourage hospices to visit patients and caregivers, provide services that will address their care needs, and improve quality of life during the patient’s last days of life. MAP observed that currently, Hospice Visits When Death is Imminent, Measure 1 and Measure 2, address this quality objective in the Hospice QRP, but the measure under consideration performed better in validity and reliability testing, and has lower provider burden because it is reported using claims data. MAP agreed that the goal of hospice is comfort. MAP encouraged that future iterations of this measure consider the quality of provider visits in addition to the quantity of visits. MAP members reviewed analysis from CMS demonstrating that not all types of provider visits correlate positively with Hospice CAHPS results. MAP examined the possible variations on the measure concept and generally agreed that the analysis supported the current proposed measure. The MAP Rural Health Workgroup noted concerns related to access to care in rural areas. Public comments expressed concern about overlap with the existing hospice visits measures. Commenters also had concerns with a hospice program’s ability to accurately identify imminent death, and with only including some members of the interdisciplinary team in the visits captured in the measure. The commenters suggested examining other options for this measure concept such as different numbers of visit |
MUC19-34: Home Health Within-Stay Potentially Preventable Hospitalization Measure |
CONDITIONAL SUPPORT FOR RULEMAKING MAP conditionally supported MUC2019-34 Home Health Within-Stay Potentially Preventable Hospitalization, pending NQF endorsement. CMS clarified that it intends to eventually replace related measures, NQF 0171 Acute Care Hospitalization During the First 60 Days of Home Health and NQF 0173 Emergency Department Use without Hospitalization During the First 60 Days of Home Health with the measure under consideration. MAP agreed that the measure adds value to the program measure set by adding an assessment of potentially preventable hospitalizations and observation stays that may occur at any point in the home health stay. No measure in the program currently provides this information. The measure supports alignment for the measure focus area of admissions and readmissions across care settings and providers. There is variation in performance on this measure, and home health agencies can implement processes and interventions that can positively influence the measure results. The MAP Rural Health Workgroup noted that older and sicker patients reflected in rural populations often have issues with access to care. MAP encouraged consideration of including Medicare Advantage patients in future iterations of the measure.” |
Source: NAHC Report
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