CMS Plans Hospice Information Set Collection to begin July 2014
May 14, 2013 08:56 AM
The Centers for Medicare & Medicaid Services (CMS) indicated in the proposed rule, FY2014 Hospice Wage Index Update, that it would make information related to the proposed Hospice Information Set (HIS), a patient-level data set, available. Additionally, CMS stated that it would seek input on the additional burden this may impose on hospice providers. The package of materialsrelated to the proposed patient-level data set is now available. Included in the package are the admission and discharge HIS forms, definitions and descriptions of the components of the HIS, and CMS’ Supporting Statement.
There are 26 questions on the Admission HIS and 12 questions on the Discharge HIS. CMS’ total estimate of time for completion of the Admission HIS is 19 minutes and 10 minutes for the Discharge HIS. With the data collected on admission and discharge through the HIS, CMS will be able to calculate the hospice’s results for seven National Quality Forum (NQF)-approved measures that are proposed in the Hospice Quality Reporting Program (HQRP).
The seven measures 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/Values Addressed (if desired by the patient)
The data details of each of the measures are found in NAHC’s HQRP Reference Table.
CMS proposes implementation of the Hospice Information Set starting in July 2014. Hospices will submit data collected on the HIS electronically to CMS, and CMS will make submission software available for the HIS to hospices at no cost. Hospice programs would be evaluated for purposes of the quality reporting program based on whether or not they submit data, but not on their performance level on required measures. There would be a 2 percent reduction in a hospice’s market basket update if it fails to submit data.
The National Association for Home Care & Hospice (NAHC) has noted in its review of the HIS documents and the HQRP Reference Table that the calculation for NQF #1647 requires the extraction of medical record documentation of events that can occur at any time during the patient’s stay in hospice. Specifically, this measure asks if there is a documented discussion of spiritual/religious concerns or documentation that the patient/family did not want to discuss. To be included in the measure calculation, such discussions or documentation of refusal can occur at admission or anytime thereafter during a patient’s enrollment in hospice care.
In the HIS-Admission form, there is a question that would capture this information. However, there is not a corresponding question on the HIS-Discharge form. NAHC has also noted that some of the timeframes specific to measures may not be collected in the HIS-Admission.
NHC will be submitting comments on this issue – and as always - appreciates feedback from the hospice community as NAHC’s official comments for submission are being developed. CMS is seeking comment on the accuracy of the time and burden estimates, as well as on any suggestions for improvement of the forms. If you have any comments or questions please feel free to contact either Katie Wehri (Katie@nahc.org) or Theresa Forster (firstname.lastname@example.org).