CMS added claim-based quality measures to the hospice quality reporting program beginning in 2021 and intends to develop additional claims-based quality measures in the future.

CMS Claims-based Quality Measure Development

CMS plans to utilize data from Medicare claims for future quality measure development for the following reasons:

      • Claims data are readily available and eliminates provider burden for implementation, as opposed to data collection through patient assessments or surveys, which require additional effort from clinicians, patients, and family caregivers before they can be submitted and used by CMS.
      • Claims are a rich and comprehensive source of many care processes and aspects of health care utilization. As such, they are a valuable source of information that can be used to measure the quality of care provided to beneficiaries.
      • Quality data submitted through claims are considered a reliable source of standardized data about the services provided and the hospices will be 100 percent compliant with submission of this information.
      • Claims data are collected based on the actual care delivered, providing a more direct reflection of care delivery decisions and actions than patient assessments or surveys.
      • Complements quality measures already in the HQRP and those considered with the implementation of the Hospice Outcomes & Patient Evaluation (HOPE).

Hospice Claim-based Measures

I.  Hospice Visits in the Last Days of Life Quality Measure

      • Fast facts about the measure:
          • Added to the HQRP in FY 2021
          • This quality measure replaces the ‘Hospice Visits when Death is Imminent’ visit pair which was part of the Hospice Item Set (HIS).
          • The Hospice Visits in the Last Days of Life (HVLDL) quality measure is not part of the Hospice Item Set (HIS).
Measure title
Hospice Visits in the Last Days of Life (HVLDL)
Measure type
Process
Data source
Hospice claims
Measure numerator
The number of patient stays in the denominator in which the patient and/or caregiver received at least two days with visits from registered nurses or medical social workers in the final three days of life
Measure denominator
All hospice patient stays enrolled in hospice except those meeting exclusion criteria.

Exclusion criteria

      1. Patient did not expire in hospice care as indicated by reason for discharge
      2. Patient received any continuous home care, respite care or general inpatient care in the final three days of life
      3. Patient enrolled in hospice less than three days.

Public reporting: 

CMS will start publicly reporting the HVLDL measure beginning no earlier than May 2022.

CMS resources:

NHPCO Resources:

II.  Hospice Care Index (HCI) Quality Measure

      • Fast facts about the measure:
          • Added to the HQRP in FY 2022
          • The HCI is a composite quality measure that has 10 individual indicators.
          • The Hospice Care Index monitors a broad set of leading, claims-based indicators of hospice care processes.
          • The 10 indicators reflect care throughout the hospice stay and by the care team within specific domains.
      • HCI Scoring:
          • A hospice is awarded a point for meeting each criterion for each of the ten claims – based indicators.
          • A hospice’s given indicator score determines whether the hospice earns a point for that individual indicator.
          • The sum of the points earned from meeting the criterion of each indictor results in the hospice’s aggregated single HCI score.
      • HCI Indicators
Indicator Point value if criterion met
1.       Provided CHC or GIP (% days) 1 point
2.      Gaps in skilled nursing visits (% elections) 1 point
3.      Early live discharges (% live discharges) 1 point
4.      Late live discharges (% live discharges) 1 point
5.      Burdensome transitions, Type 1 (% live discharges) 1 point
6.      Burdensome transitions, Type 2 (% live discharges) 1 point
7.      Per – beneficiary Medicare spending (U.S. dollars, $) 1 point
8.     Skilled nursing care minutes per RHC day (minutes) 1 point
9.      Skilled nursing minutes on weekends (% minutes) 1 point
10.  Visits near death (% decedents) 1 point

 Public Reporting

CMS will start publicly reporting the HCI measure beginning no earlier than May 2022.

CMS resources:

NHPCO Resources:

      • Coming soon: NHPCO Hospice Care Index (HCI) resource