Conquering the Hospice Item Set

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Rhonda Perrin Oakes, RN, CHPN, Regulatory Analyst, Change Healthcare and Rich Gardner, Product Manager, Change Healthcare
Hospice nurse consulting with a patient on a tablet

The importance of timing cannot be overlooked in the efficient running of a hospice organization, and that’s especially true when it comes to the Hospice Item Set (HIS). In fact, a misunderstanding over timing led to quite a few hospices receiving scores much lower than expected in the initial round of HIS submissions.

The first step is educating clinicians on the timing and requirements for each step.

An example of education could be clinicians new to hospice who may need education on the seven characteristics that must be documented for J0910c to qualify for reporting a comprehensive pain assessment.  If the clinician does not include all seven, then J0910c for that HIS would not qualify.

The first step toward fixing those timing issues is recognizing and understanding the three stages in the HIS process:

Care processes are completed and documented

  1. Clinician performs care processes
  2. The Hospice Quality Reporting Program (HQRP) has timing requirements or specific inclusivity on certain care processes in order for the item to be included in the data collection
  3. Per agency policy, the HIS tool is completed

Ready to submit

  1. Hospice Item Set is completed and ready
  2. HIS has timing requirements recommended by CMS for completion and submission

Ready to monitor

  1. HIS is submitted
  2. Organization checks the validation reports to ensure the data is accepted
  3. Resubmit when required (timely)
  4. Ensure all applicable patients have a matching HIS admission and HIS discharge

Expectations, updates, and fitting it all in

Because of the multiple steps involved in the process (submitted does not mean accepted, for example) hospice staff need to fully understand timing expectations. Generally speaking, an organization would want their timing targets to be half of the CMS recommended times.  If CMS recommends 30 days to complete a submission, the hospice should strive for  submission within 15 days.  This gives the organization some leeway for unexpected events (staff sickness, etc.) and still have time for data collection, documentation, submission, revision and resubmission, if needed, and acceptance.

Importantly, all education materials should be updated to reflect current recommended timelines or better.  For instance, hospice or palliative care patients who screened positive for pain must receive a clinical assessment of pain within 24 hours (it formerly was 48 hours).

Clinicians also must understand that while data collection may have a recommended 14-day window, this should not be confused with care process timing.  Certain tasks must be completed in 24 hours to qualify for reporting efforts.

Finally, it’s a good idea to put in place systems that allow for efficient, yet careful, monitoring of care processes, completion rates of HIS measures based on HQRP reporting specifications and CMS recommended HIS submission timeliness.

The information provided in this Change Healthcare site is provided to you for informational purposes only. The materials are general in nature, are not offered to you as advice on a particular matter, and should not be relied on as such. Use of this web site does not constitute a legal contract or consulting relationship between Change Healthcare and you.

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