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Doug BalserNational Client Educator

Zeb ClaytonVP of Client Services

Winning Wednesday Webinar Series

SHP FOR HOSPICEUpdates for HIS 2.0

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Today’s AgendaSHP Updates for HIS 2.0 ▸ Overview of HIS 2.0

▸ Review of Changed HIS HQRP Measures

• Impact of Removing the 7 Day LOS Requirement▸ Review of New HIS HQRP Measures

▸ Review of SHP Reporting Updates

• HQRP Analysis and HQRP Executive Advantage• HQRP Patient Detail• HQRP Service Utilization Patient Detail• Hospice Executive Advantage• Potentially Avoidable Events/Patient Detail

▸ Future SHP for Hospice Projects

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Overview of HIS 2.0

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HIS 2.0▸ The admission assessment has 3 new

data collection items and 1 modified item:

▸ A0550: Patient ZIP Code

▸ A1400: Payor Information (11 choices)

▸ J0900: Skip logic removed on J0900C when pain severity is “None”

▸ J0905: Pain Active Problem

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HIS 2.0▸ The discharge assessment has 14 new data

collection items, all in a new section: Service Utilization

▸ O5000: Level of care in final 3 days

▸ O5010: Number of hospice visits in final 3 days

▸ O5020: Level of care in final 7 days

▸ O5030. Number of hospice visits in 3 to 6 days prior to death

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Review of Changed HIS HQRP Measures

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Treatment Preferences (NQF #1641) and Beliefs/Values Addressed (NQF #1647)

▸One change was made to both the Treatment Preferences and the Beliefs/Values measures:

Previous Numerator Window: Prior to admission orwithin 5 days of the admission date.

NEW Numerator Window: No more than 7 days priorto admission or within 5 days of the admission date

▸This change has a very minimal impact on the overall score for this measure

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Removal of the 7 Day LOS Requirement▸ The following measures formerly excluded patients

that were on service for less than 7 days:• Treatment Preferences (NQF #1641)• Beliefs/Values Addressed (NQF #1647)• Pain Screening (NQF #1634)• Pain Assessment (NQF #1637)• Dyspnea Screening (NQF #1639)• Dyspnea Treatment (NQF #1638)

▸ These 6 measures have all had the 7 day LOS requirement removed

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Removal of the 7 Day LOS Requirement (cont.)

▸ Why the change? In the 2017 Hospice Final Rule on pages 64-65, CMS explained:

“The impact of the LOS exclusions on the distribution of hospices’ scores is generally small for all of the QMs. In addition, these analyses revealed that the care processes targeted by the QMs are performed on the day of, or within one day of, admission for the vast majority of patient stays. For example, among patient admissions for which a pain screening was administered, approximately 92 percent of screenings occurred on the day of admission and close to 99 percent occurred within 1 day of admission.”

▸ In order to look at the impact to the HIS scores, we analyzed the outcomes including and excluding the LOS exclusion

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LOS Comparison (<7 days vs. >=7 days)▸ Based on an analysis of over 2 million hospice episodes in the

SHP database that were completed in 2016, around 30% of all patients had an LOS of less than 7 days.

▸ Below is a comparison of the scores for the 6 affected quality measures for that period.

Source: SHP National Database

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New LOS Parameter Filter▸A new Minimum Length of Stay

parameter has been added to the HQRP Analysis and HQRP Executive Advantage reports that allows you to replicate the former 7-day LOS criteria if desired

▸By default, this parameter will be set to All Patients

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Review of New HIS HQRP Measures

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New Measure: Hospice Visits Last 3 Days

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New Measure: Hospice Visits Last 7 Days

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New Measure: Composite Process Measure

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Review of SHP Reporting Updates

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HQRP Analysis Updates▸ Removed the 7 day LOS requirement and

changed the default for the date parameter to run by Discharge Date

▸ Added the 3 new HQRP measures to the Measure Summary page

▸ Added Measure Detail pages for the 3 new HQRP measures

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HQRP Analysis Measure DetailHospice Visits when Death is Imminent: At Least 1 Visit in Last 3 Days of Life

▸ This new Measure Detail page provides breakdowns of visits in the last 3 days of life, including: Patients that had at least one visit from an

RN/MD/NP/PA Patients that had at least one visit, but from a

SW/Chaplain/LPN/Aide only, not from anRN/MD/NP/PA

Patients that had No Visits documented

▸ Breakdowns are also provided for: Percent of Routine Home Care Patients with Visits in

Last 3 Days Patients that Did Not Meet Measure - Visits in

Days 3 - 6

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HQRP Analysis Measure DetailHospice Visits when Death is Imminent: At Least 2 Visits in Last 7 Days of Life▸ This new Measure Detail page provides

breakdowns of visits in the last 7 days of life, including: Patients that had at least 2 visits from a

SW/Chaplain/LPN/Aide Patients that had only 1 visit from a

SW/Chaplain/LPN/Aide Patients that had at least 1 visit, but from an

RN/MD/NP/PA only, not from a SW/Chaplain/LPN/Aide Patients that had No Visits documented

▸ Breakdowns are also provided for: Percent of Routine Home Care Patients with Visits in

Last 7 Days Eligible for End of Life Service Intensity Add-On (SIA)

Payment (non-HQRP)

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HQRP Analysis Measure DetailComprehensive Assessment at Admission: Composite Process Measure

▸ This new Measure Detail page provides a full analysis of the Composite measure, including: Patients that had all eligible measures met Patients that had 1 eligible measure not met Patients that had 2 eligible measures not met Patients that had 3 or more eligible measures not met

▸ Breakdowns are also provided for: Percent of patients that had each of the 7 individual

process measures met

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HQRP Executive Advantage▸ Removed the 7 day LOS requirement and changed the default for

the date parameter to run by Discharge Date▸ Added support for the 3 new HQRP measures

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HQRP Patient Detail▸ Removed the 7 day LOS requirement and changed the default for the

date parameter to run by Discharge Date

▸ Added a column for the new Comprehensive Assessment measure

▸ Updated report to support the dynamic swapping of the SHP ID column with other available data types

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HQRP Service Utilization Patient Detail (NEW)▸ This new report supports patient detail reporting and drilldown functionality

for the 2 new visit-related quality measures.▸ The “Death”, “-1 Day” and “-2 Days” column groups are utilized for the At

Least 1 Visit in Last 3 Days of Life measure▸ All of the column groups are utilized for the At Least 2 Visits in Last 7 Days

of Life measure

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Hospice Executive Advantage▸ Added a new tab that reports on Timeliness of HIS Record Completion

▸ Removed 3 low-usage Potentially Avoidable Events: Unwanted CPR, Unexpected Death, and Suicides

▸ Added breakouts to the Hospitalization Potentially Avoidable Event for Alland Related to Primary DX

▸ Added breakouts to the Fall Potentially Avoidable Event for All and Observed

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Potentially Avoidable Event Patient Detail (NEW)▸ This new report replaces the patient detail section of the

Potentially Avoidable Event report and provides significantly more detail on patients that experienced potentially avoidable events

▸ The column headers can be easily sorted to help you review your results

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Comfortable Dying Analysis▸ Changed the report name from CMS Quality

Measures to Comfortable Dying Analysis▸ Removed the left-hand section of the report

that was formerly used for displaying data that would be reported to CMS

▸ Removed the discontinued Structural Measure

▸ Retired the CMS Quality Measures Overview report

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Future SHP for Hospice Projects

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Coming Soon: Hospice Scorecard Suite▸ The Scorecard Overview and Scorecard Detail reports will provide

a comprehensive look at caregiver satisfaction, quality, process, and financial metrics all on one interactive, real-time scorecard that can be run for a wide range of data types (e.g. - Case Manager, Team, Provider, Primary Diagnosis, Referral Source, and more)

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Hospice Scorecard Overview▸ Just like the SHP Home Health Scorecard Overview, The new

Hospice Scorecard Overview will provide rollups of key metric categories, including a proprietary Overall Score for each row

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Hospice Scorecard▸ Drill-down on a specific row from the

Scorecard Overview to view a full two-page scorecard for the selected item

▸ Compare performance to SHP State and National benchmarks

▸ New features include: Overall Score

Integrated CAHPS Hospice Scores

Selected Pepper Metrics

Caseload Metrics

Trended Performance

Much More!

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Conclusion

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Key Points

▸ Review and understand the changes to existing HIS HQRP quality measures (Assessment time windows, removal of minimum LOS requirements, etc.)

▸ Review and understand the new HIS HQRP quality measures (Service Utilization, Comprehensive Assessment)

▸ Be prepared to start reviewing scores for the new measures in late April/early May as soon as sufficient HIS 2.0 data is available

▸ On-demand training videos for each of the reports we reviewed today are being produced and will be available soon

▸ The recorded version of this presentation will be available on SHP University™ within the next week, and a link will be sent out via email as well

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Questions and Answers

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Winning Wednesday Webinar Series

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