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In April 2016 CMS commented that it was considering development of a new hospice patient assessment tool as part of the Hospice Quality Reporting Program (HQRP). This tool, known now as HEART – Hospice Evaluation and Assessment Reporting Tool, would replace the current Hospice Item Set (HIS). The tool was developed fairly quickly and the first round of pilot testing began in January 2018 with the second round scheduled to begin in summer 2018. However, CMS recently announced that further testing phases are being delayed to assure that concerns raised during the first round of testing are addressed. CMS is working diligently to retool the HEART following the lessons learned in the first round.
CMS further stated that it will have significant interaction with stakeholders during the process and will hold Special Open Door Forums (SODF) with two planned thus far – September and December 2018. A specific date and time have not yet been released.
The retooling of the HEART is a significant development. CMS has been moving rather expeditiously on the HEART tool, and it is believed the tool is one of the key components necessary for future changes in hospice including payment refinement.
CMS states the key concepts in developing a hospice assessment tool are:
- To understand the care needs of people through the dying process
- To ensure the safety and comfort of individuals enrolled in hospice institutions nationwide
And, the goal is to have a hospice assessment tool that enables providers to use it as part of the plan of care and CMS to calculate quality measures based on the data.
Hospice is currently the only post-acute care (PAC) setting without a CMS-mandated assessment instrument. CMS acknowledges that it must be recognized that hospice care differs from other PAC settings, but there is a need to create a comprehensive assessment instrument for hospice care to align with other PAC settings, where feasible and practical. As such, objectives of a comprehensive assessment instrument must include the ability to establish goals of care that embrace the individual’s values and preferences and are consistent with a person-centered approach that values the person and caregiver in the care continuum with an emphasis on physical, psychosocial, spiritual, and emotional support.