Eli's Hospice Insider

Published on Mon Sep 23, 2013 PDF

Gear up now for the July 1 start date for HIS.

Get ready to fill out 27 data items at every hospice admission, thanks to new Medicare hospice regulations.

As proposed in May, the Centers for Medicare & Medicaid Services has finalized a seven-item Hospice Item Set (HIS) for hospice patients, according to its hospice 2014 payment final rule published in the Aug. 7 Federal Register.

The HIS items are:

NQF #1617 Patients Treated with an Opioid who are Given a Bowel Regimen;

NQF #1634 Pain Screening;

NQF #1637 Pain Assessment;

NQF #1638 Dyspnea Treatment;

NQF #1639 Dyspnea Screening;

NQF #1641 Treatment Preferences;

NQF #1647 Beliefs/ValuesAddressed (if desired by patient).

The HIS set includes 27 items at admission and 13 questions at discharge (including the signature of the person verifying record completion).

Hospices that fail to start reporting the data in July 2014 will see a 2 percent reduction to Medicare rates in 2016, CMS says.

Commenters had protested that data about #1647 is collected at admission only, when the National Quality Forum measure indicates it could be any time in the stay.

CMS has chosen to stick with the admission-only collection. “Addressing patients’ values/ beliefs and preferences for treatment by providing an opportunity for patients and families to discuss their preferences during the comprehensive assessment period is an important step in ensuring the delivery of hospice care that is patient and family-centered,” CMS maintains. It also aligns with hospice Conditions of Participation stating “that the comprehensive assessment ‘‘must identify the physical, psychosocial, emotional and spiritual needs related to the terminal illness that must be addressed in order to promote the hospice patient’s well-being, comfort, and dignity throughout the dying process.”

“We recognize that the discussion can take place at any time in the course of a patient’s hospice care but believe the patient should be offered the opportunity to address these concerns in the early days of care when they are more likely to be able to do so,” CMS explains. “We consider it best practice.”

As proposed, CMS will end collection of its two current quality measures, NQF #0209 and the structural/QAPI measure, at the end of this year, with the final reporting date in April 2014.

Do not make the mistake of ceasing collection of that data now, warns the National Hospice & Palliative Care Organization. “Hospices should continue to collect data for these two measures through December 31, 2013,” NHPCO urges.

Stay tuned: CMS will publish detailed instructions for HIS in a forthcoming user guide, the agency promises.

Resource: The Paperwork Reduction Act packet of materials on the HIS tool, which contains the admission form, discharge form, item descriptions, and burden estimates, is at www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html — scroll down to the April 29 listing for “Hospice Item Set.” For a copy of the admission and discharge forms and direct link to the package, e-mail editor Rebecca Johnson at rebeccaj@eliresearch.com with “HIS forms” in the subject line.

CMS also finalizes its proposal for collection of its Experience of Care survey, a patient and family satisfaction tool. CMS is field testing it this fall, and plans to require hospices to begin collecting data in 2015 to impact 2017 payment rates.

Many commenters complained that the draft survey is way too long and “daunting,” CMS says in the rule. The Family Evaluation of Hospice Care (FEHC) is 54 questions, notes the National Association for Home Care & Hospice.

Response: CMS plans to pare down unnecessary items in its field testing, it assures hospices in the rule. “We actually anticipate that the final survey instrument will be significantly shorter than the FEHC,” CMS notes. As a comparison, the field tested Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey had 54 items and now the final survey has 34 items.

Like HHCAHPS, CMS plans to require use of a third-party vendor to collect and report the survey data.