• Patients younger than 18 years old at the start of the HH stay.
• HH stays beginning with a Low Utilization Payment Adjustment (LUPA) claim.
• Patients receiving services from multiple HHAs during the HH stay.
• Patients not continuously enrolled in Part A FFS Medicare for the 12 months prior to the HH stay.
• The patient is missing information needed for risk adjustment.



• HHS NQS Priority: Communication and Care Coordination
  
  
• HHS Data Source: Claims
  
  
• Measure Type: Outcome
  
  
• Steward: Centers for Medicare & Medicaid Services
  
  
• Endorsement Status:
  
  
• Meaningful Measure Area: Admissions and readmissions to hospitals
  
  
• Is the measure specified as an electronic clinical quality measure? No
  
  

Preliminary Analysis of Measure

• Preliminary analysis result: Conditional Support pending NQF review and endorsement
  
  
• Preliminary analysis summary
  • Contribution to program measure set:This measure adds value to the program measure set by adding measurement of potentially preventable hospitalizations that occur at any point in the home health stay. There is not a measure in the program currently that provides this information. There is variation in performance on this measure and home health agencies have the ability to implement processes and interventions that can positively influence the measure results.
  • Impact on quality of care for patients:Collecting information on potentially preventable hospitalizations and providing home health agencies with information and feedback will encourage agencies to assess for factors that influence these hospitalizations and perform interventions to reduce patient’s risk for a hospitalization. Patients will be able to spend more time in their home and stay out of the hospital.
  
  
  
• Does the measure address a critical quality objective not currently adequately addressed by the measures in the program set? Yes. This is a new measure that has not been reviewed by a MAP Workgroup or used in a CMS program.There are measures in this program set that address different aspects of this quality objective, namely unplanned readmissions in the first 60 days of home health care and hospital admissions post-home health discharge. This measure focuses on potentially preventable hospitalizations (admissions or observation stays) that occur during a HH patient stay. It covers the entire episode of a home health care stay.To define potentially preventable hospitalizations, the developer convened a Technical Expert Panel that reviewed an initial list that was compiled through an environmental scan, clinical, and technical input. A condition was considered potentially preventable if clinical experts determined that there was some process or clinical action a home health agency could do as part of their regular practice to prevent a hospitalization based on that specific condition.
  
  
• Is the measure evidence-based and either strongly linked to outcomes or an outcome measure? Yes. This is an outcome measure, and the developer provided some peer-reviewed literature that supports home health agencies’ ability to reduce or prevent hospitalizations during the patient stay. NQF Staff identified a literature review from 2012 that provided additional support for home health agencies’ ability to reduce or prevent hospital admissions during the patient stay (O’Connor, M. 2012).Interventions tied to reducing hospitalizations included reviewing patient medication lists for potentially inappropriate medications, telehomecare, and disease management.
  
  
• Does the measure address a quality challenge? Yes. This measure covers an area of quality assessment that is not currently addressed in the HH QRP. This measure will be the first quality measure that assesses potentially preventable hospitalizations that occur at any point during a HH patient stay. Based on CY 2016 data, the risk-standardized HH Within-Stay PPH rate was 11.4%, with a range from 0% (Min) to 26.1% (Max) and the 25th percentile at 9.3% and 75th percentile rate of 13.2%. Lower rates of PPHs suggest better provision of care. The developer notes that the measure demonstrates sufficient evidence that agencies have room for improvement. The measure is risk adjusted for age, sex, original Medicare enrollment, Activities of Daily Living (ADL), and prior care utilization using logistic regression.
  
  
• Does the measure contribute to efficient use of measurement resources and/or support alignment of measurement across programs? TBD. This measure uses data from Medicare claims, along with the data from the Medicare eligibility database (EDB), HH claims, inpatient claims, and outpatient claims data, resulting in minimal provider burden for measurement.This measure has some overlap with an existing measure in the HH QRP: NQF #0171 Acute Care Hospitalization During the First 60 Days of Home Health. The focus areas of the two measures are different. NQF #0171 focused on unplanned admissions within the first 60 days of a home health stay. This new measure focuses on potentially preventable hospitalizations at any point in the home health stay. For the first 60 days of a stay, an admission event could be a numerator event for both measures if it met the definition of unplanned and potentially preventable.There is an additional measure in the program related to hospitalizations: Potentially Preventable 30-Day Post-Discharge Readmission Measure. This measure focuses on admissions occuring after discharge from the home health stay, thus it is related, but not competing.
  
  
• Can the measure can be feasibly reported? Yes. This measure uses data from Medicare claims, which are currently collected by CMS for payment and quality purposes.The data needed to calculate this measure are readily available and require no additional data submission beyond what is already collected on claims in the normal course of business. This measure poses no additional data collection burden to HH providers. This measure also uses the data from the Medicare eligibility database (EDB), HH claims, inpatient claims, and outpatient claims data. The EDB file provides information on dates of birth and death, patient demographics, periods of HH enrollment, and periods of enrollment in the FFS program. The data elements from Medicare FFS claims are those basic to the operation of the Medicare payment systems and include date of admission, date of discharge, diagnoses, procedures, and levels of HH care. The inpatient and outpatient claims data files are the source for beneficiary-level information on hospital and emergency room use and observation stays.
  
  
• Is the measure applicable to and appropriately specified for the program's intended care setting(s), level(s) of analysis, and population(s)? Yes. The measure is specified and tested at the facility level of analysis with home health as the care setting. The target population is all Medicare Fee-for-Service patients in the HH setting that don’t meet the exclusion criteria.The measure was tested using CY 2016 claims data incorporating 3,266,928 HH stays from 8996 HHAs.The measure was tested using claims data. The developer conducted a spilt half reliability test and demonstrated an intra-class correlation of 0.60 or moderate reliability. To test the validity of the measure, the developer tested whether a HHA’s performance on the HH Within-Stay PPH measure was correlated with its performance on other quality measures in the same clinically related group. The developer found all statistically significant [p <.001] for correlation results. In addition, the developer also held three Technical Expert Panel (TEP) meetings in which the TEP showed strong support for the face validity of the HH Within-Stay PPH measure.
  
  
• Measure development status: Fully Developed
  
  
• If the measure is in current use, have negative unintended issues to the patient been identified? N/A. This is a new measure and no negative unintended issues have been identified. However, potential considerations should be monitored. Specifically, ensuring that HHAs do not discourage patients from utilizing acute care, even when appropriate. In addition, ensuring that HHAs do not avoid patients who may be sicker or those patients who have conditions that make them more likely to be admitted.
  
  
• PAC/LTC core competency addressed by the measure: Avoidable Admissions
  
  
• IMPACT Act Domain addressed by the measure: All-condition risk-adjusted potentially preventable hospital readmissions rates
  
  
• Hospice High Priority Area addressed by the measure: N/A
  
  
• MAP Rural Health Workgroup Input:
  • Relative priority/utility: While there likely is less access to home health services in rural areas than in other areas, there are home health agencies in rural areas. The Workgroup agreed that this measure is relevant for rural residents who receive home health services.
  • Data collection issues: None
  • Calculation issues: None
  • Unintended consequences: Some research suggests that rural home health patients are relatively more ill than those in other areas, and therefore, the risk-adjustment approach must be robust to ensure fairness of comparisons. The Workgroup noted that because the HH QRP is not a pay-for-performance program, financial penalties are less likely to negatively affect rural providers.
  • Votes: Range is 1 – 5, where higher reflects more agreement regarding suitability for the program
  • Average agreement= 3.7
  • Vote Counts: (1 – 0 votes; 2 – 2 votes; 3 – 0 votes; 4 – 8 votes; 5 – 1 vote)
  • Program gap areas:The Workgroup did not discuss program gap areas.
  
  
  

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

• NQF Number (if applicable): 0
  
  
• Description: The proportion of hospice patients who have received visits from a Registered Nurse or Medical Social Worker (non-telephonically) on at least two out of the final three days of the patient's life.
  
  
• Numerator: The numerator of this measure is the number of patient stays in the denominator in which the patient and/or caregiver received at least two days with visits from registered nurses or medical social workers in the final three days of life, as captured by hospice claims records.Registered nurse visits are identified by revenue code 055x (with the presence of HCPCS code G0299); Non-telephone visits are MSWs are identified by revenue code 056x (other than 0569; HCPCP code G0155)
  
  
• Denominator: The denominator for the measure includes all hospice patient stays enrolled in hospice except those meeting exclusion criteria.
  
  
• Exclusions: Patient stays are excluded from the measure if the patient did not expire in hospice care or if the patient received any continuous home care, respite care, or general inpatient care in the final three days of life.The exclusion criteria are:1.Patient did not expire in hospice care as indicated by reason for discharge (exclude if PTNT_DSCHRG_STUS_CD does not equal [40, 41, or 42]]); OR2.Patient received any continuous home care, respite care or general inpatient care in the final three days of life (exclude if revenue codes = [0652, 0655, or 0656]).3.Patient was enrolled in hospice at least three days.
  
  
• HHS NQS Priority: Communication and Care Coordination
  
  
• HHS Data Source: Claims; CAHPS Hospice Scores
  
  
• Measure Type: Process
  
  
• Steward: Centers for Medicare & Medicaid Services
  
  
• Endorsement Status:
  
  
• Meaningful Measure Area: End of life care according to preferences
  
  
• Is the measure specified as an electronic clinical quality measure? No
  
  

Preliminary Analysis of Measure

• Preliminary analysis result: Conditional Support for Rulemaking with condition of removal of competing measures
  
  
• Preliminary analysis summary
  • Contribution to program measure set:The value to the program measure set would come from replacing existing measures with a lower-burden measure with higher validity and reliability testing results.
  • Impact on quality of care for patients:Collecting information about hospice staff visits for measuring quality of care will encourage hospices to visit patients and caregivers and provide services that will address their care needs and improve quality of life during the patients' last days of life.
  
  
  
• Does the measure address a critical quality objective not currently adequately addressed by the measures in the program set? Yes. This is a new measure that has not been reviewed by a MAP Workgroup or used in a CMS program. There are currently two measures that address this quality objective in the Hospice QRP: Hospice Visits When Death is Imminent, Measure 1 and Hospice Visits When Death is Imminent, Measure 2. Measure 1 assesses the percentage of patients receiving at least 1 visit from Registered Nurses, Physicians, Nurse Practitioners or Physician Assistants in the last 3 days of life. Measure 2 assesses the percentage of patients receiving at least 2 visits from Medical Social Workers, Chaplains or Spiritual Counselors, Licensed Practical Nurses or Hospice Aides in the last 7 days of life. This measure performed better in validity and reliability testing than these measures and has lower provider burden because it is reported using claims data.
  
  
• Is the measure evidence-based and either strongly linked to outcomes or an outcome measure? Yes. This is a process measure, and the developer noted that there is evidence 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.
  
  
• Does the measure address a quality challenge? Yes. This measure addresses a high-priority area by assessing hospice staff visits to patients and caregivers during the final days of life when patients and caregivers typically experience higher symptom and caregiving burdens, and therefore a higher need for care. Collecting information about hospice staff visits for measuring quality of care will encourage hospices to visit patients and caregivers and provide services that will address their care needs and improve quality of life during the patients' last days of life. The developers conducted testing using 100% of Medicare hospice users discharged to death in FY2018 (n=1.1 million beneficiaries) for this measure. The mean measure score across 3,569 hospices in FY 2018 was 64.8% (median 70.2%; IQR 53.0%-80.9%). Thus, an average of only approximately 65% of Medicare hospice patients and/or caregivers received at least two days with visits from registered nurses or medical social workers in the final three days of life.
  
  
• Does the measure contribute to efficient use of measurement resources and/or support alignment of measurement across programs? Yes. This measure overlaps with the existing measures in the program, specifically Hospice Visits When Death is Imminent Measure 1 and Measure 2. If this measure replaces one or both of the existing measures, it will contribute to efficient use of measurement resources and support alignment. If all three measures remaining in the program, it will result in duplicate measurement within the program.In testing, the proposed measure demonstrated higher results on validity and reliability testing. Validity was assessed by calculating the correlation between the measure scores and the hospice’s percentage of caregivers who would recommend the hospice. For existing Measure 1 the Pearson correlation coefficient was 0.2166 and for existing Measure 2, the correlation coefficient was -0.0984. For the proposed measure the correlation coefficient was 0.2418. Thus, the proposed measure was slightly more correlated in the validity assessment of the hospice’s percentage of caregivers who would recommend the hospice. The developer assessed reliability using split-half reliability analysis. For existing Measure 1 the intraclass correlation coefficients was 0.861 and for existing Measure 2 the coefficient was 0.817. For the proposed measure the coefficient was 0.893. The developer indicates that the minimum threshold of acceptability is often given as 0.80.
  
  
• Can the measure can be feasibly reported? Yes. The measure is constructed entirely from hospice claims records from the Medicare Hospice Benefit, which are already collected by CMS for payment and quality purposes. Therefore, this measure poses no additional data collection burden to hospice providers. If it replaces existing measures and items are able to be removed from the HIS, it could reduce existing provider reporting burden.
  
  
• Is the measure applicable to and appropriately specified for the program's intended care setting(s), level(s) of analysis, and population(s)? Yes. This measure is specified at hospice care setting and level of analysis. The target population for this measure is Medicare Part A enrolled beneficiaries electing hospice services (all beneficiaries in Medicare Advantage convert to Fee-for-Service when electing hospice).
  
  
• Measure development status: Fully Developed
  
  
• If the measure is in current use, have negative unintended issues to the patient been identified? N/A. This is a new measure, not previously used in the program. No potential unintended consequences were identified or reported by the developer.
  
  
• PAC/LTC core competency addressed by the measure: Achievement of patient/family/caregiver goals
  
  
• IMPACT Act Domain addressed by the measure: N/A
  
  
• Hospice High Priority Area addressed by the measure: N/A
  
  
• MAP Rural Health Workgroup Input:
  • Relative priority/utility: There was some concern about the availability of medical social workers in rural areas. The Workgroup was not sure whether this measure, which likely would replace two measures that assess visits by other hospice providers (e.g., LPNs, aid), would or would not benefit rural patients.
  • Data collection issues: The Workgroup noted this measure should reduce data collection burden as data can be derived from claims.
  • Calculation issues: The Workgroup noted that the measure may not be fair to rural providers if rural areas have a higher proportion of hospice enrollees with illnesses with a less predictable trajectory.
  • Unintended consequences: If late enrollment in hospice is an issue in rural areas, this measure may be unfair for rural hospice agencies.
  • Votes: Range is 1 – 5, where higher reflects more agreement regarding suitability for the program
  • Average agreement= 2.8
  • Vote Counts: (1 – 0 votes; 2 – 4 votes; 3 – 8 votes; 4 – 1 vote; 5 – 0 votes)
  • Program gap areas: The Workgroup did not discuss program gap areas.
  
  
  

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 Index

• Inpatient Rehabilitation Facility Quality Reporting Program 
  
  
• Skilled Nursing Facility Quality Reporting Program 
  
  
• Home Health Quality Reporting Program 
  
  
• Long-Term Care Hospital Quality Reporting Program 
  
  
• Hospice Quality Reporting Program 
  
  

Full Program Summaries

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: