Hospice Quality Reporting Data & Trends October 19 th, 2017 Presented by Zeb Clayton, VP of Client Services, SHP Chris Attaya, VP of Product Strategy, SHP Robert Love, DeVero
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Objectives Setting the Stage Background on the Hospice Quality Reporting Program (HQRP) Trends and Benchmarks in Hospice Item Set (HIS) data and CAHPS Hospice What s next? The direction quality reporting is likely to take 3
Setting the Stage Background on HQRP 4
CMS Hospice FY 2017 Final Rule CAHPS Hospice The CAHPS Hospice Survey is the first national hospice experience of care survey that includes standard survey administration protocols that allow for fair comparisons across hospices. CMS will publicly report hospice data when at least 12 months of data are available (April 2015 official start after dry run quarter) CMS noted in the rule that the CAHPS Hospice Survey will be reported on an eight-quarter rolling average, although initially fewer quarters will be reported as they ramp up Hospices that have fewer than 50 survey-eligible decedents/caregivers in the period from January 1, 2016 through December 31, 2016 are exempt from CAHPS Hospice Survey data collection and reporting requirements for the FY 2019 payment determination. 5
CMS CAHPS Hospice Changes CMS announced last year that the eleven Quality Measures that are calculated from the CAHPS Hospice survey have been simplified and consolidated. Three of the measures have been eliminated and their questions were added to other existing Quality Measures, leaving six composite measures and two global measures. The recently posted National CAHPS Hospice Survey dataset on Data.Medicare.gov reflects these changes. 6
Summary of CY 2017 Final Rule - HIS Seven day LOS requirement removed Change to Treatment Preferences and Beliefs/Values measures requiring that the questions be asked no more than 7 days prior to admission New Composite Measure New Measure Pair Set for Hospice visits when death is imminent HIS 2.0 Continue to pursue new data collection considerations (post- HIS 2.0) 7
HIS Measures LOS Analysis Discharges October 2016 September 2017 8
CMS HQRP January Update A CMS Hospice Compare website, which will provide valuable information regarding the quality of care provided by Medicare-certified hospice agencies throughout the nation, is expected to be available in the late summer of 2017 (August 2017 - HIS; Winter 2018 CAHPS Hospice) The seven currently available Hospice Item Set (HIS) based quality measures (QMs) as well as eight CAHPS Hospice based quality measures will be reported on the Hospice Compare website The two new HIS based measures (Hospice and Palliative Care Composite Measure and the Hospice Visits When Death is Imminent Measure pair) will not be incorporated into Hospice Compare at this time Like other CMS Compare websites, the Hospice Compare website will, in time, feature a quality rating system that gives each hospice a rating of between one and five stars 9
CMS HQRP January Update (cont.) CMS calls included reference to following Inpatient Rehabilitation Facility (IRF) and Long term Care Hospitals (LTCH) compare sites. That comparison raises the following questions: Will CAHPS be on a second tab? Will there be state averages? On other sites there is a 6 month delay on CAHPS, but a 9 month delay on other measures. Will we see the same pattern here? Similarities to Home Care Compare: CAHPS scores will be reported using a combination of composite (multiquestion) and universal (single question) domains Process measures are compared to both the state and national benchmarks HIS-based HQRP measures will be reported using a rolling 12-month period that is updated each quarter 10
CMS Hospice Compare 11
CMS Hospice Compare 12
CMS Hospice Compare https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/hospice- Quality-Reporting/Hospice-Quality-Public-Reporting.html 13
HIS Measure Update Crosswalk Click here to download the SHP Crosswalk that documents these changes. 14
HIS 2.0 as of 4/1/17 The admission assessment has 3 new data collection items and 1 modified item: A0550: Patient ZIP Code A1400: Payor Information (11 choices) J0900: Skip logic removed on J0900C when pain severity is None J0905: Pain Active Problem 15
HIS 2.0 as of 4/1/17 (cont.) The discharge assessment has 14 new data collection items, all in a new section: Service Utilization O5000: Level of care in final 3 days O5010: Number of hospice visits in final 3 days O5020: Level of care in final 7 days O5030. Number of hospice visits in 3 to 6 days prior to death 16
Trends and Benchmarks in HIS and CAHPS Hospice Data 17
SHP CAHPS Hospice Scores Quarterly Trends 18
SHP CAHPS Hospice Scores Quarterly Trends 19
SHP CAHPS Hospice Scores Lowest Ratings 20
CAHPS Hospice Key Drivers Compares the correlation of overall rating to other survey questions 21
SHP HIS Scores Year over Year Trends 22
CMS Hospice Compare Scores 23
HIS Composite Assessment at Admission 24
HIS Visits when Death is Imminent Two New Measures 25
At least 1 Visit in Last 3 Days of Life SHP National Benchmark (4/2017 9/2017) 26
Percent of Routine Home Care Patients with Visits in Last 3 Days SHP National Benchmark (4/2017 9/2017) 27
At least 2 Visits in Last 7 Days of Life SHP National Benchmark (4/2017 9/2017) 28
Percent of Routine Home Care Patients with Visits in Last 7 Days SHP National Benchmark (4/2017 9/2017) 29
What s next? The direction quality reporting is likely to take 30
CMS Discussion What do we know? New Composite Measure New Measure Pair Set for Hospice visits when death is imminent CMS states: The HQRP promotes the delivery of person-centered, high quality, and safe care by hospices CMS has sought to adopt measures recommended by multi-stakeholder organizations and developed with the input of providers, purchasers and/or payers, and other stakeholders Comparing performance between hospices requires that measures be constructed from data collected in a standardized and uniform manner
When is a 95 not an A? 32
CMS Discussion Star Ratings Differentiating hospice agencies Clusters vs. linear algorithms (percentile ranking) Public impact of stars Two sets of stars like home care or combining into one overall score as in Home Health Value Based Purchasing (HHVBP)
CMS Discussion What do we know? Measure Concepts under Consideration for Future Years: While CMS has not proposed any new measures as part of the FY2018 rule, the proposed rule does provide discussion of priority area measure concepts under consideration for future years, including: Potentially Avoidable Hospice Care Transitions Access to Levels of Hospice Care Sets the tone
CMS Discussion Quality Measures What is hospice quality? good death? Live discharge? Death in under 3 days? 7 days? What is the impact of providers? How are patient goals measured? Palliative care vs Hospice Care across settings- does place change quality? Linked to resource use [Abt Study]?
CMS New Assessment HEART Tool Hospice Evaluation & Assessment Reporting Tool Abstracting vs. Assessment - what are the pro s and cons? How does the form impact the value? What items are included for measure? Whose assessment? Hospice is interdisciplinary. How is this the same as or different than OASIS? Differentiation of agencies: Can everyone be excellent?
Hospice 2018 Final Rule Commentary What is Hospice Quality? Congruence of place of death and patient wishes Psychological, psychiatric, and psychosocial aspects of care Spiritual well-being Bereavement services offered by a hospice Volunteer services offered by a hospice Occupational therapy outcomes Provider commitment to credentialing their staff Care Planning regular goal reviews with family Timely communication of patient s goals Cost of care Care coordination among providers
Summary Public reporting has begun Home Care has been there learn from them Identify opportunities to address quality improvements in HIS and CAHPS Hospice Understand the Caregivers perspective and expectations Monitor closely and develop best practices Be prepared for the public impact What do you want measured?
Questions? For More Information: Email: info@shpdata.com Phone: (805) 963-9446 39
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