Quality data crucial for hospices in value-based reimbursement

Understanding payer priorities in defining quality scope is essential for hospices to thrive not only in traditional health insurance, but also in today’s value-based reimbursement climate.

The finer details of data tracking and management are important when it comes to ensuring both healthy outcomes and quality patient care. This includes performance on quality measures required by the US Centers for Medicare & Medicaid Services (CMS), Hospice Care Index (HCI), Hospice Item Set, and Consumer Assessment of Healthcare Providers and Systems surveys (CAHPS).

A hospice’s track record of these measures is also important when it comes to

Medicare Advantage Plans. CMS requires plans to ensure they are working with high quality care providers. This means that they will look closely at supplier quality data.

Effective processes to measure and track quality are crucial for hospices when it comes to proving their value proposition to payers, according to Dr. Alena Baquet-Simpson, chief medical officer of insurance giant Aetna, a company CVS Health (NYSE:CVS).

“It is essential that [hospice] providers and payers are actively evaluating key performance indicators (KPIs) against CMS requirements and actual service performance,” Baquet-Simpson told Hospice News in an email. “Priorising these measures is crucial to improving health outcomes and reducing costs for enrollees.”

MA in particular plans to focus on provider star ratings, which began appearing on the CMS Care Compare website last month. CMS currently bases these assessments on the Hospice Item Set, HCI and Consumer Assessment of Healthcare Providers & Systems (CAHPS) scores. These data are key considerations when plans choose providers for their networks.

According to Yancey Bond, director of solutions management at WellSky, a national healthcare software company, poor scores compared to other vendors can impact a hospice’s competitive position in payment markets. value based.

How a hospice collects information about its quality performance can create both risks and rewards by gaining a competitive advantage in the world of payers, she told the Financial Management Conference of the National Association for Home Care & Hospice (NAHC) in Las Vegas.

Suppliers may find themselves wading through murky waters as they figure out how to track and report quality in a way that payers understand and find useful.

Payers most carefully monitor indicators such as the number of patient visits in the last days of life, symptom management across the spectrum of their palliative care and any expensive services provided, according to Katy Barnett, director of policy on home care and palliative operations. to seniors’ advocacy group LeadingAge.

Perhaps the greatest measure of quality in the eyes of payers, according to Barnett, are the outcomes and experiences reported by family members and caregivers.

“Patient outcomes are a really big topic that payers are looking at,” Barnett told Hospice News. “We are seeing an expansion of the palliative care quality metric space, and it’s certainly interesting to know who they’re going to partner with. Keeping someone comfortable at the end of life and how a hospice manages all those symptoms and costs is something both private and public health care payers are considering.

CMS implemented the HCI in its 2022 Final Rule for Palliative Care Payments to illustrate the care processes that occur between admission and discharge of a palliative care patient. Each supplier receives a unique numerical score ranging from zero to 10, based on a set of quality indicators.

Although these indicators are designed to paint a picture of the care a patient receives, some providers have greeted the HCI with confusion and concern. Some players have questioned these thresholds, arguing that the differentiation between palliative care homes is insufficient for a justified comparison.

To differentiate themselves from the competition, hospices need to cast a wide net when looking at patient population data to proactively identify those at risk of discharge alive, according to Bond.

“It’s important that you monitor and prevent live discharges,” Bond said at the NAHC conference. “Let data drive where you seek to help your clinicians and empower them to better serve your patients. You can be the source of change within your market, impacting issues, if you leverage the data to ensure that you will achieve this quality metric.

Providers should keep in mind that payers are likely to use quality data beyond what they can see in health insurance claims or publicly available reports, according to Mollie Gurian, vice president of Home and Home and Community Services Policy at LeadingAge.

“If you’re a hospice and you get into some sort of relationship with a health plan, they’re probably going to ask about things that aren’t made public,” Gurian told Hospice News. “It can be beneficial to collect data on things about your readmission rates, ED utilization, and medication management, as these are ways that help reduce payer costs and increase patient satisfaction. It’s important for hospices that payers don’t have a lot of context about what a quality score actually means and how it applies and translates to the overall plan of care.

Going forward, quality data related to measures to improve health equity will be on payers’ radars, Gurian added. Both the CMS and MA plans are increasingly looking at how hospices deal with access issues within their service communities, with a requirement for “some kind of quality data reporting” foreseen in a near future, Gurian said.

The Accountable Care Organization Realizing Equity, Access and Community Health (ACO) REACH payment model deployed as part of the Center for Medicare & Medicaid Innovation (CMMI) “Refresh Strategy” emphasizes equity of care of health in the design of the payment model. ACO REACH is one of the first new models to use this approach, although others may emerge that include diversity, equity and inclusion components.

To tie all the quality data together, hospice staff need to understand their role in capturing this information and how their employer, CMS and payers use it, said Cindy Campbell, director of operations consulting at WellSky.

Hospices must be strategic in how they educate and train staff at all levels, because how they document and interpret data is just as crucial as how they collect it, she added.

“It’s about thinking about the quality of what we do in palliative care and whether or not that’s rewarded in a market,” Campbell said at the NAHC conference. “If you have ‘damaged data’ in the results, then you have a staffing issue with the assessment and understanding of how to enter patient data. You need to be able to manage organizational, individual and team behaviors to help these metrics constantly improve and move in the right direction. »

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