We are going to highlight two important outcome measures and data reporting that will be incorporated into the Care Compare site for Hospice. Specifically, the Hospice Visits in the Last Days of Life (HVLDL) measure, and the new Hospice Care Index (HCI).

Hospice Visits in Last Days of Life Measure

The Hospice Visits in Last Days of Life Measure will be replacing the measure of Hospice Visits when Death is Imminent. The Hospice Visits in Last Days of Life Measure is specific to the percentage of your patients that have had visits at least two of the last three days of life, and that is specific to RNs and Medical Social Workers. LPN visits and Medical Social Worker calls do not count. Understand that days are being counted, not visits. For example, if a Medical Social Worker and RN both went on the same day, that is still only counted as one day. 

Hospice Care Index

To assist patients and family members in making decisions about the Hospice that will provide care to their family members, the Hospice Care Index has expanded the information that is provided for public review.

As you can see in the graphic below, there are ten components of the calculation of the Hospice Care Index. Listed here are items that are individually calculated based on your agency’s claims data.

Each item is worth one point or no points. The Hospice Care Index has maximum score of ten. These items are calculated based on where the calculations fall in the percentile ranks in the sample chart above.

Two items that should be looked at closely are items 8 and 9, Skilled Nursing Care Minutes per Routine Home Care Day, and Skilled Nursing Minutes on Weekends.  Without having the units that are reported on the claims, there is no way for CMS to know the minutes that you have spent on a visit. Your claims need to reflect the 15-minute increments of time that your clinicians are spending in the home, ensuring that the claim reflects the units based on the actual in and out times from their visit.

There has been some concern surrounding item 2, which is Gaps in Skilled Nursing Visits. This is the percentage of your patients that go more than seven days without receiving a skilled nursing visit. One of the questions that surround this is whether the calculation includes Registered Nurses only, or if LPN visits are counted? The answer is that LPN visits are counted as the measure is based on Skilled Nursing Visits, not just Registered Nursing Visits.

It is important that we begin to understand these new measures and how they are going to impact public reporting. As stated earlier, the public is looking at the Care Compare site and there comparing one Hospice to another to help make the decision as to where their patient might be receiving care.

If you need any assistance with the Hospice Quality Reporting Program measure reviews, please don’t hesitate to let us know.