Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
As part of the development of hospice quality measures, Abt Associates, under contract with CMS, convened a Technical Expert Panel (TEP). This report provides a summary of their first in-person, November 2019 TEP Meeting. It includes background on the focus of this TEP and purpose of developing the Hospice Outcomes and Patient Evaluation (HOPE), a real-time hospice assessment instrument, its role in quality measurement, and some quality measurement considerations, including outcome and claims-based measures. Please navigate to the HOPE webpage to access this TEP Report.
The direct link to this 34-page report is here. I’ve provided the Executive Summary below to get your review started.
The Centers for Medicare & Medicaid Services (CMS) contracted with Abt Associates under a Measure & Instrument Development Support (MIDS) Task Order to support the overall Hospice Quality Reporting Program (HQRP) including the development, maintenance, implementation and re-evaluation of structural, process, outcome and composite measures that are reflective of the quality of hospice care provided through Medicare. The HQRP promotes delivery of patient centered, high-quality, and safe care, and is currently comprised of the Hospice Item Set (HIS) and the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS).
Currently, HQRP measures are based on information collected at admission and discharge, with no information being collected in real time on patient conditions and needs during their hospice stay for the purpose of quality measures. Furthermore, there is limited information of physical, social, emotional, and spiritual needs of the hospice patient in the HQRP quality measures. In response to this, CMS is investing in the development of a new hospice assessment instrument, called the Hospice Outcomes & Patient Evaluation (HOPE) to improve care and care planning in real-time and to provide aggregate data on the quality of care provided by a hospice. Data from HOPE will also inform development of new quality measures that will be publicly reported by CMS. Abt solicited input on potential new hospice quality measures from a Technical Expert Panel (TEP).
The TEP met in November 2019 to discuss concepts for new quality measures for HQRP. For each measure concept, the TEP was provided a rationale based on information-gathering and policy considerations for each concept. Abt also shared concepts on target populations and exclusions for the measures. The TEP provided thoughtful feedback on HOPE-based measures and claims-based measure concepts; this feedback informs quality measures (QMs) to be developed for HQRP. Measure concepts discussed included pain, dyspnea, caregiver wellbeing, patient preferences, and claims-based measures.
The Abt team and CMS will consider TEP feedback towards these measure concepts that emphasize the importance of patient preferences, reducing provider burden, and changes in patient data if changes in condition occur.