The Status of Quality Measure Development in Hospice – Part 2

Hospice Compare:

The Challenges with Process Measures and “After-the-Fact” Experience Surveys 

In 2017, CMS launched its Hospice Compare website, which helps consumers compare hospice providers on certain measures of performance to assist them in making important healthcare decisions.¹²  The information provided on Hospice Compare comes from two sources: the Hospice Item Set (HIS), which measure the interdisciplinary team’s activities at patient admission and discharge, and the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey.¹³ 

Unfortunately, the HIS data set has limitations, as documented in the MedPAC’s 2019 Report to Congress.¹⁴ The HIS data set does not provide valuable insights into care provided throughout a patient’s hospice experience or any meaningful insights into differences between hospices.¹⁵ 

While the CAHPS survey focuses on experience, it is administered after a patient’s death, gathering the family caregivers’ perspective on their experience with hospice care after the fact. CAHPS questions revolve around communication, respect, getting timely help, and willingness
to recommend.¹⁶  

“The challenge with the HIS data set, in particular, is that it measures care processes, not patient outcomes,” said Katherine Ast, MSW, LCSW, Director of Quality and Research at the American Academy of Hospice and Palliative Medicine. “Process measures solely look at if a certain process was done (e.g., pain assessment) but not whether the process was actually helpful to the patient. It remains difficult to define positive outcomes in hospice at all, since patient goals most likely differ from patient goals in other settings. If goals have been defined, then the challenge becomes where to find that documentation in the patient record. With all the challenges, the actual data collected may not offer consumers useful information about how hospices differ from one another.”