New Quality Reporting Requirement for Hospice Providers

The Centers for Medicare and Medicaid Service’s (CMS) posted the FY2017 Hospice Wage Index final rule on August 5, 2016 with updates to quality reporting for hospice providers that will be effective in 2017.

The FY2017 Hospice Wage Index final rule will bring some new and interesting changes to Medicare hospice quality reporting. While there will be no changes to the seven hospice item set (HIS) measures, CMS confirmed that two new quality process measures will be implemented in 2017. The two new measures include:

1.  Hospice Visits When Death is Imminent

This is a process measure pair that assesses hospice team member visits to patients and their family in the last week of life. The first measure of the pair assesses the percentage of patients who received at least one visit from either/and a registered nurse, physician, nurse practitioner, or physician assistant in the last three days of life for the purpose of case management and clinical care provision.  The second measure of the pair assesses the percentage of patients who received at least two visits from either/and a medical social worker, chaplain or spiritual counselor, licensed practical nurse, or hospice aide in the last seven days of life. This second measure in the pair allows providers flexibility to provide care that is individualized for the patient/ family’s preference and measurable goals of care. The process measure pair data will be collected as four new items on the HIS discharge record beginning April 1, 2017.

2. Hospice and Palliative Care Composite Process Measure

This quality process measure uses the current seven HIS measures as its components and calculates the percentage of patients for whom HIS admission records contain data on all seven HIS quality measures. The individual component of the composite measure is assessed separately for each patient and is then aggregated into one score for each hospice.

Final Reminders for Hospice Providers:

• Providers who do not submit data to CMS per regulatory requirements will be subject to a two percentage point reduction to the market basket percentage increase for that fiscal year.  This includes failure to report HIS data and/or CAHPS data.
• CMS confirmed the following compliance thresholds for the submission of HIS records in the final rule:
  • January 1, 2016 to December 31, 2016 - 70 % of all required HIS records must be submitted within the 30 day submission timeframe or 2% deduction will impact FY2018 payment
  • January 1, 2017 to December 31, 2017 - 80 % of all required HIS records must be submitted within the 30 day submission timeframe or 2% deduction will impact FY2019 payment
  • January 1, 2018 to December 31, 2018 - 90 % of all required HIS records must be submitted within the 30 day submission timeframe or 2% deduction will impact FY2020 payment

Members of NHPCO will find a comprehensive Regulatory Alert looking at the Final Rule available online.

By Jennifer Kennedy, MA, BSN, RN, CHC
NHPCO Senior Director, Regulatory and Quality