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Equity:

Expect Health Equity Quality Measures In Your Future

Published on Wed Apr 13, 2022

Get in your 2 cents about the measures before it’s too late.

Medicare is taking health equity seriously, and it wants your feedback to help it do so.

The Centers for Medicare & Medicaid Services “is working to advance health equity by designing, implementing, and operationalizing policies and programs that support health for all the people served by our programs, eliminating avoidable differences in health outcomes experienced by people who are disadvantaged or underserved, and providing the care and support that our enrollees need to thrive,” CMS says in the hospice payment proposed rule for 2023 released on March 31.

“Health inequities persist in hospice and palliative care, where Black and Hispanic populations are less likely to utilize care and over 80 percent of patients are White,” CMS notes. “After hospice admission, racial and ethnic disparities appear to impact quality of care and health outcomes. Black patients may receive fewer supportive care medications despite higher symptom burdens, experience care less consistent with their expressed preferences, and encounter worse end-of-life communication,” CMS highlights in the rule scheduled for publication in the April 4 Federal Register.

CMS notes that it has received helpful comments on the topic in previous rulemaking cycles, and it wants to solicit more feedback from hospices. The rule asks a series of open-ended questions regarding a variety of equity-related topics ranging from demographic data collection to recruiting staff, volunteers, and board members from diverse populations.

Plus: “We are considering a structural composite measure based on information already collected by hospices,” CMS says. “Specifically, the structural composite measure could include organizational activities to address access to and quality of hospice care for underserved populations.”

One way to structure the measure would be using three “domains” addressing a hospice’s strategic plan and activities; training for staff, volunteers, leaders, and board members; and organizational inclusion and equity initiatives.

“We are interested in developing health equity measures based on information collected by hospices not currently available on claims, assessments, or other publicly available data sources to support development of future quality measures,” CMS summarizes. “We are soliciting public comment on the conceptual domains and quality measures described in this section. Furthermore, we are soliciting public comments on publicly reporting a composite structural health equity quality measure; displaying descriptive information on Care Compare from the data hospices provide to support health equity measures; and the impact of the domains and quality measure concepts on organizational culture change.”

Health equity is a high priority across the board at CMS, as evidenced by CMS Administrator Chiquita Brooks-LaSure’s comments about President Biden’s 2023 budget proposal (see related story, p. 8). “At CMS, we will work to advance equitable health care systems so that all people, especially the underserved, are able to access high quality care when and where they need it,” Brooks-LaSure says in a Department of Health and Human Services release.

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