Understanding the Hospice Item Set

We’re all too aware of CMS’ focus on quality as it relates to pain and symptom management.  As hospice providers, we have had to prepare for the upcoming public reporting of these, and other, quality indicators.  With the most recent addition to quality reporting being the Hospice Item Set (HIS), hospice care is being scrutinized more than ever before.  Pain and dyspnea here, family satisfaction there…the requirements for each can be confusing and cumbersome to track! 

The data collection for the HIS started on July 1, 2014.  For every admission from that date forward, hospices are required to collect and aggregate quality data on 7 key indicators determined by CMS – Treatment Preferences, Beliefs/Values Addressed, Pain Screening, Pain Assessment, Dyspnea Screening, Dyspnea Treatment, and Patients Treated with an Opioid Who Are Given a Bowel Regimen.  Sounds overwhelming, right?  In reality, the majority of these data elements should already be captured during the initial assessment and care plans.  I like to think of HIS as a useful tool as it is forcing providers to extract the required data from the initial assessment which can then be tracked over time versus having to sift through each nursing note to gather the same data. 

Once all of the HIS information is collected it then has to be submitted to CMS electronically through the QIES ASAP system.  CMS has defined a strict timeline for submission of this information (within 30 days of admission or discharge).  First, providers have to separate out a bunch of data, and now they have a deadline to quality check and submit it?  Again, overwhelming, right?  But, providers want to be sure that they’re monitoring these deadlines as CMS will begin reducing the reimbursement rate by 2 percentage points for FY 2017 if it’s not done timely. 

Ok, so now that providers have all of this data pulled aside, what do they do with it?  This is where quality skills will come into play.  The information on the HIS is extremely valuable.  Providers can now quickly and easily compare admission data from the HIS to discharge data from the staff’s notes for a single patient, group of patients, or an entire census.  Providers can also correlate the HIS data to the CAHPS survey data and determine if there are any trends.  Were pain, anxiety, and dyspnea controlled?  Were the patient and family’s end of life expectations met?  Is there a trend with one particular team whose patients consistently have high pain scores?  This information can be aggregated and used as a baseline for a Performance Improvement Project (PIP).  While PIPs might be a necessary evil, many providers could all use a little drill-down to help determine where improvement is needed.