At a recent CMS Open Door Forum (ODF), hospices received the expected news. CMS announced that they would be publicly reporting the Hospice Quality Reporting Program (HQRP) quality measures in 2017, likely in the summer. Hospices have been collecting HQRP data using the Hospice Item Set (HIS) since July 1, 2014, but the results have not been made public. That changes next year.
How are hospices scoring? As expected, after the initial few months of setting up new processes and procedures to track and submit scores, hospice outcomes have steadily improved. The attached graph shows two of the measure improvements over the last 15 months.
Since these results are essentially process measures, most hospices have achieved very high scores with one exception, the Pain Assessment measure. Although scores for this measure have trended up over the last two years, there is still significant room for improvement. This chart reflects a quarterly comparison of eligible patients (excluding patients under age 18 and patients on service for fewer than 7 days) from 2014 Q4 to 2015 Q4.
| Eligible | Q4 2014 | Q4 2015 | Change |
|---|---|---|---|
| Treatment Preferences | 98.3% | 99.5% | 1.2% |
| Beliefs/Values Addressed (if desired by the patient) | 94.9% | 97.6% | 2.7% |
| Pain Screening | 96.0% | 97.7% | 1.7% |
| Pain Assessment | 75.6% | 87.7% | 12.2% |
| Dyspnea Screening | 97.7% | 98.6% | 1.0% |
| Dyspnea Treatment | 93.4% | 97.3% | 3.8% |
| Patients Treated with an Opioid who are Given a Bowel Regimen | 93.3% | 96.8% | 3.5% |
We’ve learned that the specific requirement that patients must be on service for at least 7 days to be eligible for 6 of the 7 HQRP measures (excluding the Opioid-Bowel Regimen measure) has been removed in the January 12th, 2016 release of the HQRP users’-manual eligibility requirements. Patients are now considered eligible for all 7 measures regardless of their length of stay. The note indicates this modification will be submitted and reviewed by the National Quality Forum (NQF). Based on 2015 data from the SHP national database, 27.4% of hospice patients would have been excluded due to having an episode that lasted fewer than 7 days. Data from that same period shows that patients with shorter lengths of stay are scored lower on 6 of the 7 measures, with the “Pain Assessment” measure scoring a whopping 13.3% lower for patients on service for fewer than 7 days.
To be ready for public reporting, hospices must start working now to ensure that these previously ineligible patients are meeting all applicable quality measures.
Comparison of Eligible vs. Ineligible Patients
Please join SHP on April 27th for the next presentation in our Winning Wednesday Webinar series, "HQRP: How hospices are scoring and what changes to expect...", as we explore and share further insights on the Hospice HQRP program changes and explore in more detail hospice performance over the last couple of years.
Tags
