What You Should Know for Better Quality Care Under HQRP

An exceptional patient experience is dependent on high quality care. Medicare-certified hospices are assessed for the quality of care they provide and the patient experience at end-of-life through the Hospice Quality Reporting Program (HQRP).

The HQRP is mandated by the Affordable Care Act of 2010, under Section 3004, to establish quality reporting requirements for hospice programs. The program requires quality data to be submitted by hospices through the Hospice Item Set (HIS), and the Hospice CAHPS.

It is essential to measure the performance of your hospice to know that you are providing quality care which consequently leads to exceptional patient experiences at end-of-life. The information from HIS has the potential to improve your Hospice CAHPS scores and explore potential future measures. Here’s a look at HIS, CAHPS and how relate to quality outcomes.

What is HIS and CAHPS?

The Hospital Item Set (HIS) is a set of data elements that can be used to calculate 7 quality measures; treatment preferences, beliefs and values addressed, pain screening and pain assessment, dyspnea screening and dyspnea treatment, and patients treated with an opioid who are given a bowel regimen. The HIS is not administered to the patient, or the family or the caregivers. The item set is a standardized mechanism for abstracting data from the medical record.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey is made to measure and assess the experiences of patients who died while receiving hospice care, as well as the experiences of their informal primary caregivers. The focus of CAHPS Hospice Survey is on the patient’s and caregiver’s experiences of care. The implementation of the survey aims to fulfil national priorities for improving care: involving patients and families in care and promoting effective communication and coordination. The CAHPS Hospice Survey consists of 47 standardized questions based on the following measures: 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.

How do you comply with HQRP?

The HQRP is currently “pay-for-reporting”. This means that the act of submitting quality data determines compliance with HQRP requirements. Fulfilling the Hospice CAHPS Survey requirements and HIS data submission requirements is used to determine reporting compliance with HQRP. The performance level is not a consideration when determining market basket updates or Annual Payment Updates (APU).

8% of the hospices did not report HIS quality measures and will have a 2% point reduction in the FY2016 APU. CMS will uphold the 2% reduction if clear evidence to support a finding of compliance is not present. Of course, as mentioned before, compliance is determined by submitting the documentation for HIS and CAHPS.

It is essential for hospices to have processes in place to ensure accurate and timely reporting of quality measure to CMS. It’s important to look at the intersection between HIS (Hospice Item Set) and the CAHPS (Consumer Assessment of Healthcare Providers and Systems) Hospice Survey. By improving processes related to the HIS measures, the CAHPS results should also go up.

Develop a process to ensure compliance with HIS and CAHPS. It’s important to understand how HIS measures can impact CAHPS scores and the connection between HIS, CAHPS and quality outcomes. To learn more about recent changes to HQRP and proposed new measures, and to get advice on what a hospice can do to prepare, check out this audio conference “Hospice Quality Reporting Program – What can you do now….” by expert speaker Charlene Ross, MSN, MBA, RN. Charlene has successfully analyzed problems, developed and simplified procedures, and implemented innovative solutions to improve organizational operations for hospitals and hospice programs across the country.

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