Quality Measures: Will the CMS Palliative Care Index Really Work?

The US Centers for Medicare & Medicaid Services (CMS) designed the Hospice Care Index (HCI) to paint a picture of the care processes that occur between a patient’s admission and discharge, but as currently designed, it may not be an effective measure of quality.

Payers and referral partners are paying greater attention to hospice performance on publicly available quality metrics, which starting in FY2022 include the HCI. Each supplier receives a unique numerical score ranging from zero to 10, based on a set of quality indicators.

But some stakeholders have questioned those thresholds, arguing that the differentiation between hospices is insufficient for a grounded comparison, according to Carter Bakkum, senior data analyst for healthcare insights at Trella Health.

“I think the basic concept [of the HCI] is a very good idea, and it’s something that should definitely be explored,” Carter Bakkum, senior healthcare data analyst at Trella Health, told Hospice News. “But when almost 40% of palliative care agencies have a value of 10, it doesn’t give much nuance. It does not differentiate the best of the best from a mediocre person.

To calculate HCI scores, CMS uses claims data to determine whether a hospice has met certain performance thresholds for each of 10 indicators. The agency then awards the supplier a point for each threshold reached and adds them together to determine the final score. If the hospice reaches five of the 10 thresholds, for example, it will receive a score of five.

Currently, about one-third of hospice agencies have an HCI score of 10, and about 82.2% of National Provider Identifiers (NPIs) are between 8 and 10, according to Trella Health research.

This lack of differentiation can be especially tricky for hospices that operate in smaller markets, Bakkum said. In Wyoming, for example, 20 of the state’s 21 hospices have a score of seven or higher.

Simply put, CMS thresholds can make it too easy for vendors to earn points.

For early live releases, for example, hospices must be below the 90th percentile to earn a point. They should outperform the bottom 10% of providers.

This means that a hospice that beat 99% of its competitors would receive the same number of points as a provider that did better than just 11%.

It is difficult to assess which hospice has achieved the desired results more consistently.

“It’s a binary value, and it doesn’t necessarily give a good indication that they were working well,” Bakkum said. “If they’re in the 89th percentile, they get a point even though they were worse than 89% of other hospice agencies.”

The HCI might be more effective if CMS used a median or mean to calculate the score, according to Bakkum.

In addition to early live discharges, indicators include: ongoing home care (CHC) or general inpatient (GIP), gaps in skilled nurse visits, late live discharges, insurance spending -sickness per beneficiary, skilled nursing minutes per day of routine home care, skilled nursing minutes on weekends and near-death visits.

The HCI also uses two indicators for binding transitions. The first is live discharges from hospice followed by hospitalization and subsequent readmission to hospice. The second indicator is living discharges from hospice followed by hospitalization with the patient dying in hospital.

Provider HCI scores will soon be made public on the CMS Care Compare website, along with a number of other quality metrics. This can have a profound impact on a supplier’s business.

As hospices move toward value-based care, they will need to leverage strong performance on this data in their negotiations with payers. Medicare Advantage plans, for example, look closely at star ratings, quality data, and Consumer Ratings of Healthcare Providers and Systems (CAHPS) when determining which providers to include in their networks. .

This data is also becoming a key factor in mergers and acquisitions, with strategic buyers and investors paying close attention to quality metrics when identifying companies to buy.

Additionally, a growing number of patients and families are using Care Compare when choosing a hospice to care for them.

“Star ratings aren’t just consumer-facing metrics — although that’s how many Medicare Advantage plans use them — they also dictate your earnings,” SCAN Health Plan CEO Dr. Sachin Jain previously said. , to Hospice News. “If you have a big Medicare Advantage book like ours, the change from a four and a half star rating to a four star rating is actually tens of millions of dollars.”

Maria D. Ervin