The Hospice Item Set (HIS) is one aspect of the Hospice Quality Reporting Program (HQRP) that was mandated by the Affordable Care Act of 2010 and set under section 1814(i)(5) of the Social Security Act. The HQRP is an initiative to ensure hospices provide quality care for all patients, both clinically and emotionally. The HQRP includes data submitted by hospices through the Hospice Item Set data collection tool, and an experience of care survey, the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS).
Compliance with the HQRP reporting is determined by successfully fulfilling both the HIS data submission requirements and the Hospice CAHPS Survey requirements.
Ensuring HQRP Compliance
Starting in the fiscal year 2014, failure of hospice organizations to submit required quality data will result in a two percent reduction in their market basket percentage increase for that fiscal year. The HQRP is currently set as a “pay-for-reporting” system, meaning it is the act of submitting timely and complete data to avoid the two percent reduction in reimbursement. Performance on the quality measures themselves is not a consideration when determining annual payment updates (APU).
The HQRP data is publicly available for people to be informed on how each hospice performed on the results derived from the HIS and CAHPS® quality measures. Starting in August 2017, the Social Security Act required public reporting through a website controlled by the Centers for Medicare and Medicaid Services (CMS). Their Hospice Compare website is a tool to compare hospice providers’ performance and assist consumers in making decisions that are right for them.
The HIS Data Collection Tool
All Medicare-certified hospices will require a HIS to be completed, regardless of the payer. Once the HIS is submitted, some patients will be excluded from the calculations for quality measure reporting. These patients include those under the age of 18, patients who have a HIS discharge record but no HIS admission record, and patients who have a HIS admission record but no HIS discharge record. For hospices to meet the submission requirements and avoid the 2% reduction in APU, 90% of the hospice’s patients need to have HIS records submitted to and accepted by CMS within the 30-day submission deadline.
Data is received to complete the HIS from either the HIS questions directly answered in clinical documents or by abstraction from documentation in the clinical record.
Anything that is not documented in the hospice software from the clinical record, either directly or through abstraction, is not considered to have occurred and should not be entered into the HIS.
Assessment of HIS Data
The HIS questions are divided into the following areas:
- Administrative Information
- Active Diagnoses
- Health Conditions (Pain and Dyspnea)
- Service Utilization
- Record Administration
Streamlining the HIS Submission Process
Axxess Hospice provides the ease and speed of an internal HIS document tool, the HIS Export Manager, which enables users to manage their HIS processes easily. The HIS Export Manager automatically populates HIS data for required documents, ensuring easy submission and modification. Because it’s made by hospice professionals who know how busy hospice professionals are, the HIS Export Manager even has a daily countdown for each document so deadlines (and revenue) won’t be missed.
Axxess also provides more tips and best practices in a library of useful blogs to help your hospice organization provide exceptional care.