The Status of Quality Measure Development in Hospice – Part 3

Hospice Compare:

Filling the Gap: HOPE and Claims-Based Measures

To address this issue and to fill the gaps in the measurement of hospice patients’ outcomes and experiences, CMS is working on two fronts. First, it is developing a new standardized patient assessment tool called HOPE: Hospice Outcomes & Patient Evaluation (HOPE) tool, which when finalized, will assess the clinical, psychosocial, spiritual, and emotional status and needs of hospice patients during the course of their care.¹⁷ Second, CMS is also developing a Hospice Care Index based on claims data.¹⁸ 

HOPE is an evolving standardized hospice patient assessment that stands for Hospice Outcomes & Patient Evaluation (HOPE) tool. It will assess the clinical, psychosocial, spiritual, and emotional status and needs of hospice patients during the course of their care.¹⁹ When finalized and adopted, HOPE will help consumers select a hospice for their care.²⁰

The HOPE tool will collect individual assessment items at specific points during a patient’s care, including detailed clinical information, updates on the patient’s functional status, and the preferences of the patient, family, and caregivers. According to the CMS website on HOPE, this new tool will provide “an opportunity to collect information on patients’ holistic needs and experiences of care. When standardized, a patient assessment tool allows for the measurement of quality in a way that can be compared across hospice providers and used to inform future payment refinements.”¹⁹

Very importantly for hospice providers, a standardized patient assessment tool like HOPE is designed to enhance continuous quality improvement because patient-reported data is collected in real time, able to influence care immediately, Ast said. Hospices will be able to compare their performance on each quality measure against other hospices and to the national average.²⁰

When HOPE is adopted, CMS plans to replace the Hospice Item Set with date collected through HOPE.²¹ The CAHPS Hospice Survey on patient and family caregiver experience, however, will not be affected by HOPE.²² 

CMS has completed the early development and Alpha testing phases for HOPE and is currently moving into Beta testing. Twenty Medicare-certified hospice providers participated in the Alpha testing phase, representing the diversity of hospices nationwide in terms of size, business model, geographic location, and their use of an electronic or paper-based system of data collection.²³

The Hospice Care Index is a claim-based measurement system that is also designed to fill the “measurement gap” related to the care provided during a patient’s stay with hospice. Currently, HQRP is the only CMS Quality Reporting Program in health care that does not use any claims-based measures.²⁴ 

The objectives of the claim-based measures initiative are to:

• Capture wide-ranging aspects of hospice care with a broad, holistic set of claims-based quality measures. 
• Identify indicators based on caregiver and provider feedback. 
• Align the index with family and caregiver perspectives
  from CAHPS^®.²⁵

Potential indicator topics include skilled visits, service utilization, access to all levels of care, transitions, and readmission.²⁶

During a Hospice Quality Reporting Program forum held on August 5, 2020, presenters from both CMS and Abt Associates, the quality measure developing organization, shared information about how they determined that claims-based data would help bridge hospices’ quality measures gap. 

“Claims data is the best available data for measuring care during the hospice stay. Claims data is readily available, reducing provider burden for implementation. Claims also account for care delivery decisions and actions as they occur, giving consumers a more timely reflection of care quality than other existing measures.”²⁷ 

A full transcript of the forum, including the questions and answers from participating hospice leaders, can be found online. (See the Resources list at the end of this white paper.)