Don’t let new quality metrics affect your reputation and profitability

By Carol Javens, RN, BSN, CHPN

Are you up to speed on the new Hospice Care Index (HCI) and how it may affect your hospice organization?

The Center for Medicare and Medicaid Services (CMS) has added two new quality measures to its hospice quality reporting program (HQRP) in fiscal year 2022. The quality measures are designed to help patients and their families compare hospice organizations before making care decisions. Your scores will not only affect your ability to attract new patients and secure VBID contracts from MAOs and other in-network opportunities, but it will also affect your Medicare reimbursements.

The first new measure, Hospice Visits in Last Days of Life (HVLDL), measures the number of patients who’ve received a hospice visit by a registered nurse (RN) or social worker on two of the last three days of their lives, when symptom burden is often the highest. The Hospice Care Index (HCI) provides a more comprehensive view of the level of care and services your hospice offers. It looks at 10 different aspects of your hospice’s performance throughout the hospice stay.

Know Where You Stand

HCI and HVLDL are claims-based, so you don’t need to submit additional data to CMS. However, CMS will only calculate and report your scores once a year based on the claims they receive during the annual time period. Your HCI score will be calculated based on your national ranking for each quality indicator. You receive one point for meeting the criteria set for each indicator, and your total score will be the sum of those points. Your score can range from 0 to 10, with 10 indicating you met all criteria. If you score low one year, you’ll have to wait another full year before you can receive a higher score.

Develop Insights to Manage your HCI Effectively

When you have the right mechanism for monitoring and managing the quality and cost of your care throughout the year, you can identify patterns of inappropriate or insufficient care, spend outside hospice benefits, and potential fraud. You can then address any issues proactively to maximize your HCI score and increase your opportunities to attract patients and build referral partnerships.

While many EHRs give you some of the insights you’ll need, most will not give you a retroactive view of your past performance or indicate how well you are meeting each quality indicator. You may need to invest in a solution that analyzes both your services and your patients’ claims regularly so you always know where you are and what you need to do to make your hospice better. The right analytics program will help you monitor and improve care quality and reduce costs before CMS aggregates the years’ data and publishes your score.

When considering your options, look for an analytics solution that gives you essential insights you can’t get from your EHR. Following is a list of the HCI quality indicators and the analytics capabilities that will help you address them.

  1. Continuous Home Care (CHC) or General Inpatient (GIP) Provided:
    • Days billed for CHC and GIP
  2. Gaps in Nursing Visits:
    • Review of Patients on service for incremental care delivery
  3. Early Live Discharges and Proactive Planning:
    • Timely alters when a patient enters the ED to minimize live discharges on or before the 7th day in hospice
    • Mortality indicators
    • Complete medical history to justify length of stay
  4. Late Live Discharges and Proactive Planning:
    • Longevity prognostication to qualify patients for hospice and avoid live discharges after the 180th day
    • Mortality indicators
    • Complete medical history to justify length of stay
  5. Burdensome Transitions (Type 1):
    • Identification of patients at high risk for revocation on admission so you can have a plan of care to address their needs proactively
    • Timely alerts when patients enter the ED
  6. Burdensome Transitions (Type 2):
    • Identification of patients at high risk for revocation on admission so you can have a plan of care to address their needs proactively
    • Timely alerts when patients enter the ED
  7. Pre-beneficiary Medicare Spending:
    • Automated reporting of the number of unique beneficiaries on all hospice claims in the same period for your hospice
  8. Nurse Care Minutes per Routine Home Care (RHC) Day:
    • Review of patterns that need to be addressed, including insufficient documentation at the bedside
  9. Skilled Minutes on Weekends
    • Review of patterns that need to be addressed, including insufficient documentation at the bedside
  10. Visits Near Death
    • Prognostication of when a patient has less than one week to live

Consider a Connected Care Platform Designed for End-of-Life Patients

Acclivity has developed a connected care platform specifically to help improve the care of seriously ill patients. Our platform starts with the data from your EHR and combines it with Data at the Point of Care (DPC), which includes three or more years of your patients’ Medicare claims data. Acclivity is the only platform of its kind that includes this 360o view of your patients’ medical history so that you know exactly what claims CMS will be basing your HCI scores on.

We add in essential alerts, such as frailty flags, ambulatory status, emotional and social issues, and risk factors that require additional care. Using Artificial Intelligence and machine learning, we provide meaningful insights, including predictions on when your patient has 7 days to 12 months left to live. Acclivity also helps with referrals so that you have an automated system for making those transitions smoothly and easily.

If you’d like to learn more about how analytics can enhance both your clinical decision-making and financial performance and return an impressive ROI, please reach out to us at info@acclivityheatlh.com. Or contact Robin Stawasz or me directly, or by calling us at 904-562-1368.