Posted on Wednesday, September 16, 2020
CMS is planning to revise the Hospice Quality Reporting Program (HQRP) measures and the Hospice Item Set (HIS) to remove Section O from the HIS and replace the Hospice Visits When Death is Imminent measure with a Hospice Visits in the Last Days of Life measure.
Section O of the HIS is the section where hospices enter the number of visits various staff members made to the patient in the final days of life. Visits captured include those from physicians, nurse practitioners, physician assistants, registered nurse, licensed practical/vocational nurses, hospice aides, and chaplains or spiritual counselors. This information is used to calculate the paired measure, Hospice Visits When Death is Imminent. The two measures comprising this paired measure are:
- Measure 1: Percentage of patients receiving at least one visit from registered nurses, physicians, nurse practitioners, or physician assistants in the last 3 days of life.
- Measure 2: Percentage of patients receiving at least two visits from medical social workers, chaplains or spiritual counselors, licensed practical nurses or hospice aides in the last 7 days of life.
“The visit data has been included on the HIS for a few years now and CMS intended to publicly report data for the full paired measure. However, Measure 2 did not meet readiness standards for public reporting so has been excluded from Hospice Compare while Measure 1 has been included. Data analysis revealed that measure 2 had a negative, or inverse, relationship with the CAHPS® hospice survey “would recommend” measure; that is, decedents of hospices with higher rates for measure 2 were less likely to recommend the hospice. This finding does not support previous stakeholder assumptions that visits from non-clinical disciplines in the last days of life improve the quality of hospice care as perceived by the family and caregivers. Specifically, these results indicate that, when at least two visits from medical social workers, chaplains or spiritual counselors, licensed practical nurses or hospice aides occurred in the last seven days of life (measure 2), the CAHPS® “would recommend” measure was significantly lower.”
CMS is proposing to replace the Hospice Visits When Death is Imminent measure with Hospice Visits in Last Days of Life (HVLDL) measure. The proposed HVLDL is a single measure and is based on visits by a RN or Medical Social Worker (MSW) in at least two of the last three days of life. The visit data necessary for the HVLDL measure will come directly from hospice claims eliminating the need for Section O of the HIS. Under this plan, patient discharges occurring after December 31 2020 will no longer be reported and public reporting under the new claims-based measure would begin on or about February 2021.
Source: NAHC Report
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