Time | Session |
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December 3, 2019 | |
8:30 AM | Breakfast |
9:00 AM | Welcome, Introductions, Disclosures of Interest, and Review of Meeting Objectives |
9:15 AM | CMS Opening Remarks and Meaningful Measures Update |
10:15 AM | Overview of Pre-Rulemaking Approach |
10:45 AM | Break |
11:00 AM | Home Health Quality Reporting Program (HHQRP) |
12:00 PM | Lunch |
12:30 PM | Hospice Quality Reporting Program (HQRP) |
1:30 pm | Break |
1:45 pm | Strategic Considerations |
4:30 PM | Opportunity for Public Comment |
4:45 PM | Summary of Day and Next Steps |
5:00 PM | Adjourn for the Day |
December 3, 2019 | |
8:30 AM | Breakfast |
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| |
9:00 AM | Welcome, Introductions, Disclosures of Interest, and Review of Meeting Objectives |
Gerri Lamb, MAP PAC-LTC Workgroup Co-chair Kurt Merkelz, MAP PAC-LTC Workgroup Co-chair Elisa Munthali, Senior Vice President, Quality Measurement, NQF Amy Moyer, Senior Director, NQF | |
9:15 AM | CMS Opening Remarks and Meaningful Measures Update |
Michelle Schreiber, QMVIG Group Director, CMS | |
10:15 AM | Overview of Pre-Rulemaking Approach |
Amy Moyer Janacki Panchal, Project Manager, NQF | |
10:45 AM | Break |
11:00 AM | Home Health Quality Reporting Program (HHQRP) |
Measures under consideration: | |
| |
12:00 PM | Lunch |
12:30 PM | Hospice Quality Reporting Program (HQRP) |
Measures under consideration: | |
| |
1:30 pm | Break |
1:45 pm | Strategic Considerations |
Gerri Lamb Kurt Merkelz Amy Moyer | |
4:30 PM | Opportunity for Public Comment |
4:45 PM | Summary of Day and Next Steps |
Gerri Lamb Kurt Merkelz Jordan Hirsch, Project Analyst, NQF | |
5:00 PM | Adjourn for the Day |
Measure Specifications
Preliminary Analysis of Measure
Rationale for measure provided by HHS
Factors
associated with hospitalizations from HH including functional disability,
primary diagnoses of heart disease, and primary diagnosis of skin wounds
(Lohman et al, 2017). Some other factors associated with hospitalization
include time since most recent hospitalization (Hua et al, 2015) and chronic
conditions such as chronic obstructive pulmonary disease and congestive heart
failure (Dye et al, 2018). These factors, including how HHAs address chronic
conditions present before the HH stay, can determine whether patients can
successfully avoid hospitalizations (Lohman et al, 2017). Understanding these
factors can help HHAs design strategies to address avoidable
hospitalizations.References:1. Lohman MC, Cotton, BP, Zagaria, AB, Bao, Y,
Greenberg, RL, Fortuna, KL, Bruce, ML Hospitalization Risk and Potentially
Inappropriate Medications among Medicare Home Health Nursing Patients,( 2017)
J Gen Intern Med. 32(12):1301-1308.2. Hua M, Gong, MN, Brady J, Wunsch, H,
Early and late unplanned rehospitalizations for survivors of critical
illness(2015) Crit Care Med.;43(2):430-4383. Dye C, Willoughby D,
Aybar-Damali B, Grady C, Oran R, Knudson A, Improving Chronic Disease
Self-Management by Older Home Health Patients through Community Health
Coaching (2018) Int J Environ Res Public Health. 15(4): 660
Measure Specifications
Preliminary Analysis of Measure
Rationale for measure provided by HHS
There is
evidence available from clinical organizations and panels, as well as from
individual studies, supporting the measure's basis that clinician visits to
patients at the end of life are associated with improved outcomes for both the
patients and their caregivers. The last week of life is typically the period
in the terminal illness trajectory with the highest symptom burden.
Particularly during the last few days before death, patients experience many
physical and emotional symptoms, necessitating close care and attention from
the integrated hospice team and drawing increasingly on hospice team resources
(de la Cruz 2014, Dellon 2010, Kehl 2013). Highly specific physical signs
associated with death were identified within 3 days of death (Hui et al.,
2014). Hospice responsiveness during times of patient and caregiver need is an
important aspect of care for hospice patients (Ellington 2016). Although
Medicare-certified hospices do not have any mandated minimum number of
required visits for patients in routine home care (RHC), the most common level
of hospice care, at the end of life, hospices should be equipped to meet the
higher symptom and caregiving burdens of patients and their caregivers during
this critical period (Teno 2016). Clinician visits to patients at the end of
life are associated with decreased risk of hospitalization and emergency room
visits in the last 2 weeks of the patients’ life, decreased likelihood of a
hospital-related disenrollment, as well as decreased odds of dying in the
hospital (Sewo 2010, Phongtankuel 2018, Almaawiy 2014). In addition, clinician
visits to patients at the end of life is also associated with decreased
distress for caregivers and higher satisfaction with home care (Pivodic
2016).Visits by staff who can assess symptoms and make changes to the plans of
care as well as work with the patient and the primary caregiver to provide the
appropriate palliation and emotional support (nurses, social workers, and
physicians) are important to the quality of care hospices deliver, as noted by
the NQF’s preferred practices on the recognition and management of the
actively dying patient (Teno 2016). During the development of the Family
Evaluation of Hospice Care survey, families voiced the importance of visits by
these staff in the last days of life (Teno 2016).Citations:de la Cruz, M., et
al. (2015). Delirium, agitation, and symptom distress within the final seven
days of life among cancer patients receiving hospice care. Palliative &
Supportive Care, 13(2): 211-216. doi: 10.1017/S1478951513001144Dellon, E. P.,
et al. (2010). Family caregiver perspectives on symptoms and treatments for
patients dying from complications of cystic fibrosis. Journal of Pain &
Symptom Management, 40(6): 829-837. doi:
10.1016/j.jpainsymman.2010.03.024Kehl, K. A., et al. (2013). A systematic
review of the prevalence of signs of impending death and symptoms in the last
2 weeks of life. American Journal of Hospice & Palliative Care, 30(6):
601-616. doi: 10.1177/1049909112468222Hui D et al. (2014). Clinical Signs of
Impending Death in Cancer Patients. The Oncologist. 19(6):681-687.
doi:10.1634/theoncologist.2013-0457.Ellington, L., et al. (2016).
Interdisciplinary Team Care and Hospice Team Provider Visit Patterns during
the Last Week of Life. Journal of Palliative Medicine, 19(5), 482-487. doi:
10.1089/jpm.2015.0198Teno, J. M., et al. (2016). Examining Variation in
Hospice Visits by Professional Staff in the Last 2 Days of Life. JAMA Internal
Medicine, 176(3): 364-370. doi: 10.1001/jamainternmed.2015.7479Seow, H.,
Barbera, L., Howell, D., & Dy, S. M. (2010). Using more end-of-life
homecare services is associated with using fewer acute care services: A
population-based cohort study. Medical Care, 48(2): 118−124. doi:
10.1097/MLR.0b013e3181c162efPhongtankuel, V., et al. (2018). Association
Between Nursing Visits and Hospital-Related Disenrollment in the Home Hospice
Population. American Journal of Hospice & Palliative Medicine, 35(2):
316-323. doi: 10.1177/1049909117697933Almaawiy, U., et al. (2014). Are family
physician visits and continuity of care associated with acute care use at
end-of-life? A population-based cohort study of homecare cancer patients.
Palliative Medicine, 28(2), 176−183. doi: 10.1177/0269216313493125Pivodic,
L., Harding, R., Calanzani, N., McCrone, P., Hall, S., Deliens, L., &
Gomes, B. (2015). Home care by general practitioners for cancer patients in
the last 3 months of life: An epidemiological study of quality and associated
factors. Palliative Medicine, 30(1), 64−74.
doi:10.1177/0269216315589213Pivodic, L., Harding, R., Calanzani, N., McCrone,
P., Hall, S., Deliens, L., & Gomes, B. (2015). Home care by general
practitioners for cancer patients in the last 3 months of life: An
epidemiological study of quality and associated factors. Palliative Medicine,
30(1), 64−74. doi:10.1177/0269216315589213
Program History and Structure: The Inpatient Rehabilitation Facilities Quality Reporting Program (IRF QRP) was established in accordance with section 1886(j) of the Social Security Act as amended by section 3004(b) of the Affordable Care Act. Inpatient Rehabilitation Facilities that receive the IRF Prospective Payment System (PPS) are required to participate in the IRF QRP (e.g., IRF hospitals, IRF units that are co-located with affiliated acute care facilities, and IRF units affiliated with critical access hospitals [CAHs]). Data sources for IRF QRP measures include Medicare FFS claims, the Center for Disease Control’s National Healthcare Safety Network (CDC NHSN) data submissions, and Inpatient Rehabilitation Facility - Patient Assessment instrument (IRFPAI) assessment data. The IRF QRP measure development and selection activities take into account established national priorities and input from multi-stakeholder groups. Beginning in FY 2014, IRFs that fail to submit data are subject to a 2.0 percentage point reduction of the applicable IRF PPS payment update. Public reporting of IRF QRP measures on IRF Compare (https://www.medicare.gov/inpatientrehabilitationfacilitycompare/) began in December 2016. Further, the Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT Act) amends title XVIII (Medicare) of the Social Security Act (the Act) to direct the Secretary of the Department of Health and Human Services (HHS) to require Long-term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities (IRFs), Skilled Nursing Facilities (SNFs) and Home Health Agencies (HHAs) to report standardized patient assessment data, and data on quality measures including resource use measures. The IMPACT Act requires CMS to develop and implement quality measures to satisfy at least five measure domains: functional status, cognitive function, and changes in function and cognitive function; skin integrity and changes in skin integrity; medication reconciliation; incidence of major falls; and the transfer of health information when the individual transitions from the hospital/critical access hospital to PAC provider or home, or from PAC provider to another setting. The IMPACT Act also requires the implementation of resource use and other measures in satisfaction of at least these following domains: total estimated Medicare spending per beneficiary; discharge to the community; and all condition risk adjusted potentially preventable hospital readmission rates.
High Priority Domains for Future Measure Consideration:
CMS identified the following domain as high-priority for future measure consideration:
CExchange of Electronic Health Information and Interoperability measure concept: CMS believes that IRF provider health information exchange supports the goals of high quality, personalized, and efficient healthcare, care coordination and person-centered care, and supports real-time, data driven, clinical decision making. The interoperability of health information across health care systems is key to achieving safe, efficient, and high-quality health care. It is also necessary for IRF patients/residents to fully participate in their health care.
Current Measures: NQF staff have compiled the program's
measures in a spreadsheet organized according to concepts.
Program History and Structure: The Skilled Nursing Facility Quality Reporting Program (SNF QRP) was established in accordance with the IMPACT Act of 2014, which amended 1888(e) of the SSA requiring data submission by SNFs. Skilled Nursing Facilities that submit data under the SNF PPS are required to participate in the SNF QRP, excluding units that are affiliated with critical access hospitals (CAHs). Data sources for SNF QRP measures include Medicare FFS claims as well as Minimum Data Set (MDS) assessment data. The SNF QRP measure development and selection activities take into account established national priorities and input from multistakeholder groups. Beginning in FY 2018, providers that fail to submit required quality data to CMS will have their annual updates reduced by 2.0 percentage points. Further, the IMPACT Act amends title XVIII (Medicare) of the Social Security Act (the Act) to direct the Secretary of the Department of Health and Human Services (HHS) to require Long-term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities (IRFs), Skilled Nursing Facilities (SNFs), and Home Health Agencies (HHAs) to report standardized patient assessment data, and data on quality measures including resource use measures. The IMPACT Act requires CMS to develop and implement quality measures to satisfy at least five measure domains: functional status, cognitive function, and changes in function and cognitive function; skin integrity and changes in skin integrity; medication reconciliation; incidence of major falls; and the transfer of health information when the individual transitions from the hospital/critical access hospital to PAC provider or home, or from PAC provider to another setting. The IMPACT Act also requires the implementation of resource use and other measures in satisfaction of at least these following domains: total estimated Medicare spending per beneficiary; discharge to the community; and all condition risk adjusted potentially preventable hospital readmission rates.
High Priority Domains for Future Measure Consideration:
Current Measures: NQF staff have compiled the program's
measures in a spreadsheet organized according to concepts.
Program History and Structure: The Home Health Quality Reporting Program (HH QRP) was established in accordance with section 1895 (b)(3)(B)(v)(II) of the Social Security Act. Home Health Agencies (HHAs) are required by the Act to submit quality data for use in evaluating quality for Home Health agencies. Section 1895(b) (3)(B)(v)(I) of the Act also requires that HHAs that do not submit quality data to the Secretary be subject to a 2 percent reduction in the annual payment update, effective in calendar year 2007 and every subsequent year. Data sources for the HH QRP include the Outcome and Assessment Information Set (OASIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Medicare FFS claims. Data is publicly reported on the Home Health Compare website. The HH QRP measure development and selection activities take into account established national priorities and input from multistakeholder groups. Further, the Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT Act) amends title XVIII (Medicare) of the Social Security Act (the Act) to direct the Secretary of the Department of Health and Human Services (HHS) to require Long-term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities (IRFs), Skilled Nursing Facilities (SNFs) and Home Health Agencies (HHAs) to report standardized patient assessment data, and data on quality measures including resource use measures. The IMPACT Act requires CMS to develop and implement quality measures to satisfy at least five measure domains: functional status, cognitive function, and changes in function and cognitive function; skin integrity and changes in skin integrity; medication reconciliation; incidence of major falls; and the transfer of health information when the individual transitions from the hospital/critical access hospital to PAC provider or home, or from PAC provider to another setting. The IMPACT Act also requires the implementation of resource use and other measures in satisfaction of at least these following domains: total estimated Medicare spending per beneficiary; discharge to the community; and all condition risk adjusted potentially preventable hospital readmission rates.
High Priority Domains for Future Measure Consideration:
CMS identified the following domains as high-priority for future measure consideration:
Current Measures: NQF staff have compiled the program's
measures in a spreadsheet organized according to concepts.
Program History and Structure: The Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP) was established in accordance with section 1886(m) of the Social Security Act, as amended by Section 3004(a) of the Affordable Care Act. The LTCH QRP applies to all LTCHs facilities designated as an LTCH under the Medicare program. Data sources for LTCH QRP measures include Medicare FFS claims, the Center for Disease Control and Prevention’s National Healthcare Safety Network (CDC’s NHSN) data submissions, and the LTCH Continuity Assessment Record and Evaluation Data Sets (LCDS) assessment data. The LTCH QRP measure development and selection activities take into account established national priorities and input from multistakeholder groups. Beginning in FY 2014, LTCHs that fail to submit data will be subject to a 2.0 percentage point reduction of the applicable Prospective Payment system (PPS) annual payment update. (APU). Public reporting of LTCH QRP measures on LTCH Compare (https://www.medicare.gov/longtermcarehospitalcompare) began in December 2016. Further, the Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT Act) amends title XVIII (Medicare) of the Social Security Act (the Act) to direct the Secretary of the Department of Health and Human Services (HHS) to require Long-term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities (IRFs), Skilled Nursing Facilities (SNFs) and Home Health Agencies (HHAs) to report standardized patient assessment data and data on quality measures including resource use measures. The IMPACT Act requires CMS to develop and implement quality measures to satisfy at least five measure domains: functional status, cognitive function, and changes in function and cognitive function; skin integrity and changes in skin integrity; medication reconciliation; incidence of major falls; and the transfer of health information when the individual transitions from the hospital/critical access hospital to PAC provider or home, or from PAC provider to another setting. The IMPACT Act also requires the implementation of resource use and other measures in satisfaction of at least these following domains: total estimated Medicare spending per beneficiary; discharge to the community; and all condition risk adjusted potentially preventable hospital readmission rates.
High Priority Domains for Future Measure Consideration:
CMS identified the following domain as high-priority for LTCH QRP future measure consideration:
Current Measures: NQF staff have compiled the program's
measures in a spreadsheet organized according to concepts.
Program History and Structure: The Hospice Quality Reporting Program (HQRP) was established in accordance with section 1814(i) of the Social Security Act, as amended by section 3004(c) of the Affordable Care Act. The HQRP applies to all patients in Medicare-certified hospices, regardless of payer source. HQRP measure development and selection activities take into account established national priorities and input from multi-stakeholder groups. Beginning in FY 2014, Hospices that fail to submit quality data are subject to a 2.0 percentage point reduction to their annual payment update
High Priority Domains for Future Measure Consideration:
Current Measures: NQF staff have compiled the program's
measures in a spreadsheet organized according to concepts.
General |
Hospice Visits in the Last Days of Life (Program: Hospice Quality Reporting Program; MUC ID: MUC2019-33) |