Exploring Palliative and End-of-Life-Care Quality Measures

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Rhonda Perrin Oaks, RN, CHP By Rhonda Perrin Oakes, RN, CHPN 
Regulatory Analyst, Change Healthcare
New Hospice Quality Measures

The Centers for Medicare & Medicaid Services (CMS) has been clear about its goals for hospice, which are being implemented in part through the Hospice Quality Reporting Program (HQRP). It already has implemented several metrics. Some of them are National Quality Forum (NQF)-endorsed measures, such as patients screened for pain, dyspnea, and bowel regimen if an opioid is prescribed, their preference for life-sustaining treatments, and having their beliefs/values addressed.

More recently, CMS finalized measures for:

  • The percentage of patients receiving at least one visit from an RN, physician, nurse practitioner or physician assistant in the last three days of life
  • The percentage of patients receiving at least two visits from medical social workers, chaplains or spiritual counselors, licensed practical nurses or hospice aides in the last seven days of life.

The Hospice Quality Report Program includes a composite process measure to gather data on the percentage of hospice patients who received all seven component measures of hospice and palliative care:

  1. Hospice and Palliative Care Treatment Preferences (NQF #1641)
  2. Beliefs/Values Addressed (If Desired by the Patient) (modified NQF #1647)
  3. Hospice and Palliative Care Pain Screening (NQF #1634)
  4. Hospice and Palliative Care Pain Assessment (NQF #1637)
  5. Hospice and Palliative Care Dyspnea Screening (NQF #1639)
  6. Hospice and Palliative Care Dyspnea Treatment (NQF #1638)
  7. Patients Treated with an Opioid Who are Given a Bowel Regimen (NQF #1617)

Hospice Compare is the CMS website that allows consumers to review measured information and compare hospices. While the Hospice Item Set and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey collect several measures, not all of them will display on the Hospice Compare website. The website displays the results of specific measures such as:

Patient Preferences:

  • Patients or caregivers who were asked about treatment preferences like hospitalization and resuscitation at the beginning of hospice care
  • Patients or caregivers who were asked about their beliefs and values at the beginning of hospice care

Managing Pain and Treating Symptoms:

  • Patients who were checked for pain at the beginning of hospice care
  • Patients who got a timely and thorough pain assessment when pain was identified as a problem
  • Patients who were checked for shortness of breath at the beginning of hospice care
  • Patients who got timely treatment for shortness of breath
  • Patients taking opioid pain medication who were offered care for constipation

Going forward

Many hospice and palliative care experts are participating in the Technical Expert Panels when CMS announces an opportunity. The hospice and palliative care experts are sharing their concerns. CMS has responded it is in agreement that few of the current hospice measures encourage greater coordination of care and integration across care settings. Essentially, the measures do not conceptualize care delivery across the full continuum for a person experiencing a life-threatening or life-limiting illness. The existing measures also are limited in their ability to address challenges in the Medicare population, such as chronic conditions and end-of-life conditions.

In addition to the measurements outlined here, we at Change Healthcare are monitoring several other national initiatives that could impact your care processes. These include a quality initiative by the American Academy of Hospice and Palliative Medicine called Measuring What Matters (now in phase 2); and how the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and Merit-based Incentive Payments System (MIPS) affect hospice-employed physicians and non-physician providers.

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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