Hospice Quality Reporting Program (HQRP)

ACOs need to identify the right sources for useful data, aggregate it and find meaningful insights across a lot of different areas. These areas span across care provisioning, cost management, contracting, utilization, performance and quality. As the objective is to ensure savings through effective preventive care, it is important for them to gain access to data that resides within their network and outside of it. Below are a few areas of relevance for the management team of an ACO enterprise.

For FY 2018 (reporting year 2016), all Medicare-certified hospice providers must comply with TWO reporting requirements

Submit at least 70% of all HIS records within 30 days of the event date (patient’s admission or discharge) for patient admissions/discharges occurring 1/1/16 – 12/31/16.

Ongoing monthly participation (1/1/16 – 12/31/16) in the Hospice CAHPS survey where an approved 3rd party vendor submits Hospice CAHPS data according to the quarterly deadlines.

What is HIS Data Submission?

CMS has developed a hospice patient- level item set, called the HIS (Hospice Item Set). Hospices are required to submit an HIS-Admission record and an HIS-Discharge record for each patient admission to the hospice on or after July 1, 2014. CMS offers a free tool, the Hospice Abstraction Reporting Tool (HART) that provides a means for the hospice providers to collect and maintain facility, patient and HIS Record information. Eventually providers submit HIS data to CMS through the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system.

Post-pandemic Updates

Highlighting Successful Hospices (October 1, 2020)

The CMS features a list of successful hospices for FY 2021 HQRP. Their payments for FY 2021 are the result of them successfully meeting the CY 2019 HQRP requirements. All successful hospices are primed to receive their full annual payment update (APU).The published list of hospices elucidate the potency of the HQRP and its goals.

HQRP COVID-19 Public Reporting Tip Sheet (September 8, 2020)

Since September 2020, the HQRP COVID-19 public reporting tip sheet has been available to enable providers to understand CMS public reporting strategies during the outbreak of the pandemic. The tip sheet covers CMS strategy to account for CMS quality data which were exempted from public reporting due to COVID-19.

What needs to be done?

Successful HIS data submissions, in order to achieve at least 70% data submission within 30 days of event date.

Administrative Items

Three sections contain administrative items that are primarily used for record-matching and patient identification.

  • Section A – Administrative Information
  • Section I – Active Diagnoses
  • Section Z – Record Administration

Process Items

The other three sections contain care process items that reports whether and when specific care processes took place.

  • Section A – Administrative Information
  • Section I – Active Diagnoses
  • Section Z – Record Administration

HIS Data Submission Involves

HIS Item Set  |   Submission Specifications  |   HIS Data Validation Utility Tool

From April 1st, 2016, HIS Data submission should be based on version 1.02. For this version there are no changes to HIS item set means no new items or deleted items. HIS Data Submission Specifications follow the version 1.02.0.

When a submitted HIS record is validated by the Assessment Submission and Processing (ASAP) system, its target date is evaluated and is used to load the appropriate set of edits for the specifications in effect on the target date. If the submitted record does not conform to those edits, the appropriate warning and/or fatal error messages are issued.

Once a new version of the data specs takes effect, data submission software typically handles records from the previous version (or versions) and the new version. Thus software must identify the target date for each record, determine which version of the specs applies, and use those specifications to validate the record prior to submission. Failure to do this may result in warnings, fatal errors, or unexpected results.

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