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Monitoring Quality
Today, third-party payers have a vested interest in ensuring that the care they pay for is of the highest quality. Numerous initiatives have been launched to define how quality is measured in end-of-life care settings. The initiatives and the quality measures they spawned are discussed in this chapter.
After reading this chapter, you will be able to:
■ Define required reporting structures for hospice
■ Discuss the development of a quality assessment and performance improvement (QAPI) plan
■ Identify key features of Hospice Item Set (HIS) that must be collected
Fast Facts in a Nutshell
Quality Improvement Organizations (QIOs) work under the direction of the Centers for Medicare & Medicaid Services (CMS) to help ensure that Medicare and Medicaid recipients receive high-quality, consistent care. To identify QIOs in each state, go to www.qualitynet.org, click the “Quality Improvement” tab, then “QIO Directories,” then “Quality Innovation Network.”
REPORTING REQUIREMENTS
Beginning in 2009, all Medicare-certified hospice programs were required to develop a QAPI plan as part of its Hospice Quality Reporting Program (HQRP) in order to remain eligible for Medicare funding. Specific measures were not required and each hospice developed a QAPI plan that met the unique needs of the organization (National Hospice and Palliative Care Organization, 2009).
However, hospice regulations began to change when the Patient Protection and Affordable Care Act (ACA) was passed in 2010. The regulations included new provisions for quality reporting, but the requirements did not take effect for a few years (fiscal year 2014), allowing time for organizations to align their QAPI plans with the new requirements. For Fiscal Year 2014, hospices were required to submit two quality measures that were set forth by the CMS (2011) as a condition of participation (CoP). These measures were as follows:
■ The National Quality Forum (NQF)-endorsed measure related to pain management: Specifically, hospices were required to report the percentage of patients who expressed pain on admission and the percentage of patients who reported that their pain was brought to an acceptable level within 48 hours.
■ A structural measure not endorsed by NQF: A hospice organization was required to choose three quality indicators related to patient care such as symptom management, patient safety, or documentation of patient and family goals.
Fast Facts in a Nutshell
According to the CMS (2015), the penalty for failing to submit the required data is a 2% point reduction to the market basket percentage increase for that fiscal year.
Within a few years, the second structural measure, which allowed hospice agencies to choose the aspects of patient care that would be measured, was replaced with a specific set of patient care indicators. The HIS was developed to ensure that all hospices would collect and submit the same data regardless of the patient population or location of the hospice. This approach allows for comparison between and among hospice agencies. HIS can be used to determine compliance with the six measures that were endorsed by the NQF and the one measure that is a modified NQF measure:
■ Pain screening
■ Pain assessment
■ Patients treated with an opioid who are given a bowel regimen
■ Dyspnea screening
■ Dyspnea treatment
■ Treatment preferences
■ Beliefs/values addressed
The data collected for the HIS are not direct patient assessment measures. Rather, the data are abstracted via chart review. Thus, documentation in the areas that are included is especially critical for demonstrating that quality care is consistently provided.
