A new era for hospice care begins this fall, as medical providers must report quality measures to the U.S. government on the care they provide or face financial penalty.
Though the hospice quality reporting program is in its early stages, the Obama administration and supporters see it as a way to improve end of life care and treatment when data is reported- with providers potentially benefiting from feedback in how they measure against their peers in the hospice industry.
Under the Affordable Care Act, Congress built in a number of measures and programs across all health care provider groups designed to improve the quality of medical care and potentially reduce costs, including the new “Hospice Quality Reporting Program.”
It’s the latest quality push from the Centers for Medicare & Medicaid Services — which pays for most hospice care in the U.S. via the health insurance program for the elderly and is therefore charged with rolling out the hospice quality reporting initiative– to move toward reimbursing providers for quality care and outcomes given and move away from fee-for-service medicine. The latter practice allows providers to get paid no matter the quality of care, and studies show fee-for-service medicine may lead to unnecessary or overused treatments.
“CMS’s goal is to adopt measures for the Hospice Quality Reporting Program that ensure care is patient and family-centered and is safe and high-quality,” Dr. Patrick Conway, chief medical officer and director of the Center for Clinical Standards and Quality at the Centers for Medicare & Medicaid Services said in a statement to Life Matters Media. “It is critical that hospice providers meet the care needs of all patients and families.”
The Obama administration has already rolled out quality measures for other providers of medical care as well as insurance companies, known as “Advantage plans,” that contract with Medicare to provide medical health benefits to seniors. The health plan quality program includes a star rating system to provide payment bonuses for higher-scoring plans, therefore giving consumers a better idea of which health plans seniors should choose.
For now, the hospice reporting program isn’t nearly as far along as the quality measures in the health insurance industry, nor is there an established way for the public to access what is reported to the government. However, it is believed that more information about quality will eventually lead to better care- once the data is compiled and reported back to hospice providers.
“The Affordable Care Act requires that CMS use nationally endorsed quality measures, but also allows CMS to specify measures that are not already endorsed if a feasible and practical measure in the area determined appropriate by the Secretary (of Health and Human Services) has not been endorsed,” the Centers for Medicare & Medicaid Services reports on its site for the quality reporting system, which is linked here.
One major quality measure that hospice providers must report regards pain- a critical problem for patients at the end of life. The “pain measure reflects the number of patients who report being uncomfortable because of pain at the initial assessment (after admission to hospice services) who report that pain was brought to a comfortable level within 48 hours,” the CMS web site states.
Providers are asked myriad questions, such as the so-called initial comfort question: “Are you uncomfortable because of pain?” That is asked at the time of the patient’s initial assessment.
Then, patients are asked a follow-up question as to whether their pain was “brought to a comfortable level within 48 hours of the start of hospice care?” That question is asked “within 48 to 72 hours after initial pain assessment,” according to the hospice data reporting protocol.
Providers say more questions and follow-up reporting on hospice quality could lead to improved care and potentially better diagnosis and intervention well before a patient is in need of end of life treatment. The Centers for Medicare & Medicaid Services is increasingly asking hospice providers for more and more information about the diseases patients had before they came to hospice, such as heart disease, cancer or Alzheimer’s.
Some see the additional information and quality reporting system as a way to move the government and private insurance companies further away from paying for just the quantity of hospice care delivered to paying for quality of the care at the end of a patient’s life and the performance of the medical providers who give the care during these final days.
Additionally, the quality metrics seem to encourage medical-care coordination, which some medical care providers say may one day lead to better outcomes if they can use the data to analyze diseases that put the patients into hospice care in the first place.
“We might be able to better identify diagnoses,” Julie Shackley, president and chief executive officer of Androscoggin Home Care & Hospice in Lewiston, Maine, said of the additional information being requested by the Centers for Medicare & Medicaid Services. “Are we seeing more patients with congestive heart failure? We may be able to better understand cardiac care.”
The National Hospice and Palliative Care Organization reports it “fully supports quality reporting,” though it has caused a “significant additional expenditure of resources over a short period of time” for providers, NHPCO senior vice president of health policy Jonathan Keyserling said in a statement to Life Matters Media.
A comment period on numerous new regulations facing medical care providers just ended this summer, so there could eventually be changes to the reporting program. But the current plan has already required providers to collect data from October to December of last year and submit it earlier this year. Financial penalties of a 2 percent decrease in reimbursement begin in fiscal 2014, which begins October 1 this year.
“The timeline that CMS has proposed for putting new measures in place is very ambitious and comes at a time when hospices are already dealing with reductions in payment,” NHPCO’s Keyserling added. “Quality reporting adds significantly to their burden. We encourage CMS to be aware of the many demands facing the hospice community and to continue to work constructively with NHPCO to try and reduce unnecessary burdens as much as possible.”
Bruce Japsen has written about health care for two decades, starting in his native Iowa where he covered the presidential campaign bus rides of Bill and Hillary Clinton through the Hawkeye state talking health reform and the economy. He has covered the rise, fall and rise again of health reform, chronicling national trends as well as the influence of Barack and Michelle Obama from Chicago's South Side on changes to the U.S. health system from his Chicago base. Bruce is now a contributor to Forbes Magazine, and he covered the business of health care for the Chicago Tribune from 1998-2011. He previously wrote for Modern Healthcare magazine when first arriving in Chicago in 1993. These days, he also contributes stories to the New York Times, Chicago Medicine magazine and teaches writing at Loyola University Chicago. You can hear Bruce on XM Satellite's ReachMD or in Chicago on CBS WBBM Newsradio. You can see Bruce on PBS affiliate WTTW's Chicago Tonight public affairs program. Bruce is passionate about health literacy when it comes to explaining the complexities of health care. A better understood health system may save someone money or their life.