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 quality data submission requirements and the Hospice CAHPS® Survey requirements.

A full explanation of the HIS and its importance can be found here.

What Does the HIS Measure?

The quality measures calculated using the HIS record data are:

• Treatment Preferences
• Beliefs/Values Addressed (if desired by the patient)
• Pain Screening
• Pain Assessment
• Dyspnea Screening
• Dyspnea Treatment
• Patients Treated with an Opioid Who Are Given a Bowel Regimen
• Hospice and Palliative Care Composite Process Measure – Comprehensive Assessment at Admission
• Hospice Visits When Death Is Imminent Measure Pair

The Comprehensive Assessment at Admission Quality Measure looks at the data as a group for an all-or-nothing quality measure score to indicate if an organization performed a timely and thorough assessment of all indicated areas within the indicated time frame.

Timely Completion and Submission of the HIS Data

The Centers for Medicare and Medicaid Services (CMS) is clear that it is up to the hospice to determine who in their organization is most able to complete the HIS document accurately. Each person who answers any part of the HIS should provide a signature in Section Z, Record Administration, to show that they are verifying the accuracy of the data.

CMS has recommended that the HIS-Admission record completion date be no later than 14 days from the admission date. For HIS-Discharge records, CMS recommends that the completion date be no later than seven days from the discharge date. The date of completion is recorded by the hospice provider’s selected person who verifies completion and affixes their signature to the Record Administration field Z0500 with the date the signature was provided.

For submission of both the HIS-Admission and HIS-Discharge records, CMS changes the language to should, rather than recommends.

Submission and acceptance of the HIS record, therefore, should be no later than 30 days after the admission date or discharge date.

Common Errors and Warnings After Submission

Fatal errors can occur for either attempting to submit a file that cannot be read or for submitting out-of-range responses, such as answering a 6 when the valid responses are 1, 2 and 3, or sending a record with a patient’s date of birth after their admission date. All rejected records must be corrected and resubmitted within the accepted time frame.

Warnings are non-fatal errors that include timing errors (such as a submission date greater than 30 days after the admission date) or sequencing errors (such as an HIS-Discharge being submitted before an HIS-Admission). It is the hospice organization’s responsibility to review all warnings to determine what actions should be taken to correct the error.

Where to Send the HIS Data

HIS quality data is sent to the Quality Improvement and Evaluation System and Assessment Submission and Processing (QIES ASAP) system to be processed.

Hospices may observe that they have submitted incorrect information after the record has been accepted. Errors can be rectified by submitting a Modification Request, which archives the inaccurate HIS information and replaces it with updated information, or an Inactivation Request, which archives the inaccurate HIS record but does not replace it with a new record. Hospices then would need to submit a new HIS record to CMS.

Modification Requests cannot be completed if Record Event Identifiers or Patient Identifiers are incorrect.

Record Event Indicators include:

• Admission Date
• Discharge Date
• Reason for Record

Patient Identifiers include:

• First or Last Name
• Social Security Number
• Gender
• Birth Date

In the event that one of these indicators is submitted incorrectly, an Inactivation Request must be submitted.

Streamlining the HIS Submission Process

Axxess Hospice, our cloud-based, intuitive hospice software, provides the HIS Export Manager to review, approve, send, edit or cancel your HIS records in one place. 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 care is, the HIS Export Manager even has a daily countdown for each document, so deadlines (and revenue) won’t be missed.

Axxess offers more tips and best practices in a library of useful blogs to help your hospice organization provide exceptional care.