Hospice Quality Reporting Program. CAHPS and HIS. HQRP HIS Submission Requirements

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1 Hospice Quality Reporting CAHPS and HIS Katie Wehri, CHPC Healthcare Provider Solutions, Inc. Hospice Quality Reporting Program Hospice Item Set (HIS) Admission Discharge Implemented: 2014 Payment Year: 2016 Hospice CAHPS Survey Implemented: 2015 Payment Year: 2017 HQRP HIS Submission Requirements Third year of tiered submission requirements January 1, 2018 December 31, 2018 HIS Admission and HIS Discharge must be submitted within 30 days of the applicable event Penalty 2% APU reduction for FY2020 Timeliness Compliance Threshold Report 1

2 HQRP CAHPS Hospice Survey Submission Requirements Must submit data monthly Exempt: <50 survey eligible decedents/caregivers submission and acceptance of exemption request form, annual Penalty 2% APU reduction Previously finalized through calendar year 2018 PROPOSED and FINALIZED: extend this methodology through calendar year 2020 HQRP - Submission Requirements Extensions/Exemptions Must be extraordinary circumstances beyond the control of the hospice Hospice must request the extension/exemption in writing Currently within 30 days of the circumstance occurring Finalized change FY2018 Hospice Final Rule: extend the 30 days to 90 days extend same to CAHPS Hospice Survey HQRP Public Reporting Hospice Compare Calendar year Hospice demographic data General information about hospice quality reporting Calendar year 2017 Hospice Compare site Seven HIS quality measures Individual measure scores Denominator smaller than 20 patient stays not reportable Winter 2018 CAHPS Hospice Survey 2

3 HQRP Public Reporting Hospice Compare Began summer 2017 Includes seven HIS measures Does not include CAHPS Hospice Survey measures until 2018 Winter 2018 Eight measures HIS results based on rolling 12-month period Excludes data for measures with less than 20 eligible patient stays CAHPS Hospice Survey results will be based on 8 rolling quarters Initially will include April 1, 2015 March 31, 2017 data Top box scores; risk adjusted Will exclude data for hospices receiving less than 30 responses HQRP MEASURES HIS Quality Measures NQF #1641 Treatment Preferences Modified NQF #1647 Beliefs/Values Addressed NQF #1634 & NQF #1637 Pain Screening and Pain Assessment NQF #1639 & NQF #1638 Dyspnea Screening and Dyspnea Treatment NQF #1617 Patients Treated with an Opioid who are Given a Bowel Regimen Two measures added April 1, 2017 Hospice Visits When Death Is Imminent Hospice And Palliative Care Composite Process Measure 3

4 HIS Measure Calculation HIS Quality Measures Patients under 18 excluded Denominators less than 20 patient stays excluded Composite Process Measure* Visits When Death is Imminent* Patients with LOS of 1d. or less excluded from the second paired measure (7 days) *Not in first round of Compare data HIS Quality Measures Hospice and Palliative Care Composite Process Measure Data on seven care processes will be captured Calculates the percentage of patients who received all care processes at admission Individual components assessed separately for each patient and aggregated into one score for each hospice Serves to ensure all hospice patients receive a comprehensive assessment for both physical and psychosocial needs at admission HIS Quality Measures Hospice Visits When Death is Imminent Paired measure Percentage of patients receiving at least one visit from registered nurses, physicians, nurse practitioners, or physician assistants in the last 3 days of life 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. Patient must have expired while in hospice care Excluded if receiving any care other than routine home care in the measure period 4

5 HIS Quality Measures Measure concepts under consideration Potentially avoidable hospice care transitions Access to levels of hospice care Would be claims based CMS SOLICITED COMMENTS HIS Quality Measures Potentially avoidable hospice care transitions Live discharges Shortly followed by death or acute stay Comparison of performance to peers Would be risk adjusted Common problem areas HIS Item Completion Payment sources Pain active problem and pain assessment Initiation Bowel regimen 5

6 CAHPS Hospice Survey Consumer Assessment of Healthcare Providers and Systems (CAHPS) - used in various settings CAHPS Hospice Survey designed to measure and assess the experiences of patients who died while receiving hospice care, as well as the experiences of their informal primary caregivers Standardized 47 question CAHPS Hospice Survey instrument Telephone and mail versions Composed of the following categories: Hospice Team Communication, Getting Timely Care, Treating Family Member with Respect, Providing Emotional Support, Support for Religious and Spiritual Beliefs, Getting Help for Symptoms, Information Continuity, Understanding the Side Effects of Pain Medication, and Getting Hospice Care Training HQRP - CAHPS Hospice Survey Measures Six Composite Measures Hospice Team Communication Q: 6,8,9,14,35 Getting Timely Care Q: 5,7 Treating Family Member with Respect Q: 11,12 Getting Emotional and Religious Support Q: 37,38 Getting Help for Symptoms; and Q: 16,22,25,27 Getting Hospice Care Training Q: 19,20,23,29 Two Global Measures Rating of Hospice (Q39) Willingness to Recommend Hospice (Q40) 6

7 CAHPS Hospice Survey Public Reporting Will be reported as top-box scores CAHPS Survey results risk adjustment patient mix (patient characteristics) and mode of survey administration (mail, telephone, or mixed-mode) CMS SOUGHT COMMENT: Social risk factors Examples: race and ethnicity, geographic area of residence, dual eligibility/low-income subsidy Social Risk Factors Stratified public reporting Some concerns over selective admissions Future rulemaking CMS considering publishing adjusted data and confidentially providing hospices with unadjusted data CAHPS Hospice Survey Public Reporting CAHPS Survey results risk adjustment for decedent/caregiver characteristics lag time between patient death and survey response; decedent s age, payer for hospice care, decedent s primary diagnosis, decedent s length of final episode of hospice care, caregiver s education, decedent s relationship to caregiver, caregiver s reported language used at home and language in which the survey was administered, and caregiver s age 7

8 Key Survey Questions Q6: While your family member was in hospice care, how often did the hospice team keep you informed about when they would arrive to care for your family member? Q8: While your family member was in hospice care, how often did the hospice team explain things in a way that was easy to understand? Q11:While your family member was in hospice care, how often did the hospice team treat your family member with dignity and respect? Q12:While your family member was in hospice care, how often did you feel that the hospice team really cared about your family member? Q35:While your family member was in hospice care, how often did the hospice team listen carefully to you? Hospice CAHPS Survey INFORM INFLUENCE Phase 1 Voluntary quality reporting for hospices Phase 2 Structural Measures/NQF 0209 Pain Measures Phase 3 HIS 2014 Phase 4 CAHPS-2015 Phase 5 Hospice Compare Phase 6 HEART Comprehensive Assessment Instrument Phase 7 Star Rating 8

9 PUBLIC REPORTING Data.Medicare.gov National CAHPS Hospice Survey Data National Hospice Item Set (HIS) Data HQRP - Public Reporting CASPER Hospice-Level Quality Measure(QM)Report Hospice Patient Stay-Level Quality Measure(QM) Report Preview Reports HQRP Public Reporting Public Reporting Preview Reports Available via CASPER Available prior to each quarterly update Hospices review data for accuracy and request corrections Submit proof of incorrect data Submit plan for how it will be corrected If CMS confirms error, measure will be suppressed on Hospice Compare one time with corrected measure displayed next quarter 9

10 COMPREHENSIVE PATIENT ASSESSMENT INSTRUMENT Comprehensive Patient Assessment Instrument HEART Hospice Evaluation & Assessment Reporting Tool CMS currently in early stages of development of comprehensive patient assessment instrument tool Tool would serve two primary objectives provide the quality data necessary for HQRP requirements and the current function of the HIS; and provide additional clinical data that could inform future payment refinements Comprehensive Patient Assessment Instrument Allows more detailed clinical information collection Symptom burden Functional status Patient, family, and caregiver preferences Information for use in development of future quality measures Data used for both quality and payment purposes 10

11 Comprehensive Patient Assessment Instrument HEART Would replace HIS Would NOT replace current assessment requirements Would be completed at Admission Discharge Intervals in between, possibly STAR RATING Five Star Rating HQRP Public Reporting Will be part of the HQRP Historically implemented approximately one year after Compare site Hospice may take longer 11

12 HQRP Tips Clear expectations that are well documented Orientation and training Incorporate training and competencies into ongoing staff education Teach specific guidelines and behaviors PROCESS improvement Use CAHPS language Scripting HQRP TIPS Review validation reports/data warehouse Look into the components of each measure Which questions make up the measure What is the result of each question Benchmark internally and externally Continually assess for PROCESS opportunities for improvement Standardized processes Performance improvement process Tying quality and process improvement to incentives 12

13 Katie Wehri, CHPC Healthcare Provider Solutions, Inc. Healthcare Provider Solutions, Inc. 810 Royal Parkway, Suite 200 Nashville, TN