Hospice Quality Reporting Program - Current Measures

The HIS Comprehensive Assessment at Admission (CBE #3235) captures, in a single measure, the proportion of patients for whom the hospice performed all seven care processes, as applicable. The care processes include:

1. Beliefs/Values Addressed (if desired by the patient)
2. Treatment Preferences
3. Pain Screening
4. Pain Assessment
5. Dyspnea Treatment
6. Dyspnea Screening
7. Patients Treated with an Opioid who are Given a Bowel Regimen

The HVLDL measure assesses hospice staff visits to patients at the end of life. This measure is constructed from Medicare hospice claims records. It indicates the hospice provider’s proportion of patients who have received in-person visits from a registered nurse or medical social worker on at least two out of the final three days of the patient’s life.

Note: The last three days are defined as: (Day 1) the day of death, (Day 2) the day prior to death, and (Day 3) the day two days prior to death.

The number of patient stays in the denominator in which the patient and/or caregiver received in-person visits from registered nurses or medical social workers on at least two of the final three days of the patient’s life, as captured by hospice claims records.

Note: Any visits occurring after the time of the patient’s death do not count towards the measure score.

Patients are excluded from the denominator if:

• They did not expire in hospice care as indicated by the reason for discharge
• They received any continuous home care, respite care, or general inpatient care in the final three days of life
• They were enrolled in hospice for fewer than three days

Note: HVLDL looks at visits in the last three days of life; patients must receive hospice services for at least three days to be included in the measure.

The Hospice Care Index (HCI) captures care processes occurring throughout the hospice stay, between admission and discharge. The HCI is a single measure comprising ten indicators calculated from Medicare claims data. The indicators included in the HCI are listed below this table.

The index design of the HCI simultaneously monitors all ten indicators. Collectively these indicators represent different aspects of hospice service and thereby characterize hospices comprehensively, rather than on just a single care dimension. Each indicator equally affects the single HCI score, reflecting the equal importance of each aspect of care delivered from admission to discharge.

Multi-item measure. "While your family member was in hospice care..."  P1: “How often did the hospice team keep you informed about when they would arrive to care for your family member?”  P2: “How often did the hospice team explain things in a way that was easy to understand?” P3: “How often did the hospice team listen carefully to you when you talked with them about problems with your family member’s hospice care?” P4: “How often did the hospice team keep you informed about your family member’s condition?” P5: “How often did the hospice team listen carefully to you? P6: "How often did anyone from the hospice team give you confusing or contradictory information about your family member’s condition or care?"

Note: All items have response options of “Never,” “Sometimes,” “Usually,” and “Always.”

Multi-item measure P1: “While your family member was in hospice care, when you or your family member asked for help from the hospice team, how often did you get help as soon as you needed it?” P2: “How often did you get the help you needed from the hospice team during evenings, weekends, or holidays?”

Note: Both items have response options of “Never,” “Sometimes,” “Usually,” and “Always.”

Multi-item measure P1: “While your family member was in hospice care, how often did the hospice team treat your family member with dignity and respect?” P2: “While your family member was in hospice care, how often did you feel that the hospice team really cared about your family member?

Note: All items have response options of “Never,” “Sometimes,” “Usually,” and “Always.”

Multi-item measure P1: “While your family member was in hospice care, how much emotional support did you get from the hospice team?”  P2: “In the weeks after your family member died, how much emotional support did you get from the hospice team?” P3: “Support for religious or spiritual beliefs includes talking, praying, quiet time, or other ways of meeting your religious or spiritual needs. While your family member was in hospice care, how much support for your religious and spiritual beliefs did you get from the hospice team?”

Note: All items have response options of “Too little,” “Right amount,” and “Too much.”

The top box denominator is the number of respondents who answer at least one question in the multi-item measure (i.e., one of P1 through P3).

Those who answer “Too much” are not included in measure scoring.

Multi-item measure P1: “Did your family member get as much help with pain as he or she needed?” P2: “How often did your family member get the help he or she needed for trouble breathing?” P3: “How often did your family member get the help he or she needed for trouble with constipation?” P4: “How often did your family member receive the help he or she needed from the hospice team for feelings of anxiety or sadness?”

Note: P1 has response options of “Yes, definitely,” “Yes, somewhat,” and “No.”

Note: P2, P3, and P4 have response options of “Never,” “Sometimes,” “Usually,” and “Always.”

Individual survey item asking respondents: “Would you recommend this hospice to your friends and family?”

Note: This item has response options of “Definitely no,” “Probably no,” “Probably yes,” and “Definitely yes.”