Current Measures

About this Page

The information on this webpage is specific to the quality measures (QMs) that are calculated using the Hospice Item Set (HIS), Medicare claims data, and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey. The Hospice Quality Reporting Program (HQRP) currently uses these three data sources to calculate performance on QMs.

Quality Measures Overview

HIS data is used to calculate one composite measure that is National Quality Forum (NQF)-endorsed, Hospice and Palliative Care Composite Process Measure – Comprehensive Assessment at Admission (NQF #3235). This measure includes seven component quality measures. A description of the measure is provided below. For details about the seven component measures, please refer to the HQRP QM Specifications User’s Manual v1.00 (hereafter referred to as the QM User’s Manual v1.00) located in the Downloads section at the bottom this web page. For item-level information on the HIS (e.g., coding instructions, HIS Manual), please visit the Hospice Item Set (HIS) webpage.

Two QMs are calculated using Medicare claims data, Hospice Visits in the Last Days of Life (HVLDL) and the Hospice Care Index (HCI). A description of these measures is provided below. For further details, please refer to the QM User’s Manual v1.00. 

CAHPS® Hospice Survey data can be used to calculate eight NQF-endorsed patient experience measures (NQF #2651). Details about the CAHPS® quality measures can be found below. For information on the CAHPS® Hospice Survey itself (e.g., survey questions, data collection timelines), please see the CAHPS® Hospice Survey webpage.

HQRP Quality Measure Summary  

HIS Comprehensive Assessment Measure at Admission (NQF#3235) - The portion of patients for whom the hospice performed all seven care processes as applicable.  HVLDL (NQF #3645) (Claims-based) - The proportion of patients who have received in-person visits from a registered nurse or a medical social worker on at least 2 out of the final 3 days of life.  HCI (Claims-based) - A single measure comprising ten indicators calculated from Medicare claims.  CAHPS Hospice Survey (NQF #2651) - All eight of the CAHPS H

 

  

Quality Measure Calculated using the HIS

Hospice and Palliative Care Composite Process Measure – HIS Comprehensive Assessment at Admission (NQF #3235)

Measure Description:

The HIS Comprehensive Assessment at Admission (NQF #3235) captures, in a single measure, the proportion of patients for whom the hospice performed all seven care processes, as applicable. The care processes include:

  1. Beliefs/Values Addressed (if desired by the patient)  
  2. Treatment Preferences  
  3. Pain Screening
  4. Pain Assessment
  5. Dyspnea Treatment
  6. Dyspnea Screening
  7. Patients Treated with an Opioid who are Given a Bowel Regimen

Numerator Statement:

All patient stays from the denominator who meet the numerator criteria for the individual components applicable to the patient.

Denominator Statement:

All patient stays, except for those with exclusions.

Denominator Exclusions:  

Patient stays are excluded from the denominator if they are under 18 years of age.

Measure Type:                

Process

For more information on the individual HIS-based component measures, please refer to the QM User’s Manual v1.00.

 

Quality Measures Calculated Using Medicare Claims

Hospice Visits in Last Days of Life (HVLDL) (NQF #3645)

Measure Description:

The HVLDL measure assesses hospice staff visits to patients at the end of life. This measure is constructed from Medicare hospice claims records. It indicates the hospice provider’s proportion of patients who have received in-person visits from a registered nurse or medical social worker on at least two out of the final three days of the patient’s life.

 

Note: The last three days are defined as: (Day 1) the day of death, (Day 2) the day prior to death, (Day 3) the day two days prior to death.

Numerator Statement:

The number of patient stays in the denominator in which the patient and/or caregiver received in person visits from registered nurses or medical social workers on at least two of the final three days of the patient’s life, as captured by hospice claims records.

Note: Any visits occurring after the time of the patient’s death do not count towards the measure score.

Denominator Statement:

All hospice patient stays except those meeting exclusion criteria as identified below.

Denominator Exclusions:  

Patients are excluded from the denominator if:

  • They did not expire in hospice care as indicated by reason for discharge
  • They received any continuous home care, respite care or general inpatient care in the final three days of life
  • They were enrolled in hospice for fewer than three days
Note: HVLDL looks at visits in the last three days of life; patients must receive hospice services for at least three days to be included in the measure.

Measure Type:                

Process

 

Hospice Care Index (HCI)

Measure Description:

The Hospice Care Index (HCI) captures care processes occurring throughout the hospice stay, between admission and discharge. The HCI is a single measure comprising ten indicators calculated from Medicare claims data. The indicators included in the HCI are listed below this table.

The index design of the HCI simultaneously monitors all ten indicators. Collectively these indicators represent different aspects of hospice service and thereby characterize hospices comprehensively, rather than on just a single care dimension. Each indicator equally affects the single HCI score, reflecting the equal importance of each aspect of care delivered from admission to discharge.

Numerator Statement:

The HCI does not have a traditional numerator statement. Instead, a hospice is awarded a point for meeting each criterion for each of the ten claims-based indicators. The sum of the points earned from meeting the criterion of each individual indicators results in the hospice's HCI score. HCI scores can range from 0 to a perfect 10.

Denominator Statement:

The HCI does not have a traditional denominator. The HCI score is calculated as the total number of points earned across ten indicators (hospices earn a point on an indicator when their indicator scores meet the criterion for the given indicator). The potential range of scores is from 0 to 10.

Denominator Exclusions: 

Hospices with fewer than 20 discharges in the two pooled years of data are not assigned a calculated index score per convention of CMS's quality reporting program (requiring sufficient data available to calculate reliable scores for publicly displayed measures).

Measure Type:                

Process

 

For more information on the individual indicators, please refer to the QM User’s Manual v1.00. List of HCI Indicators:

  1. Continuous Home Care (CHC) or General Inpatient (GIP) Provided 
  2. Gaps in Skilled Nursing Visits 
  3. Early Live Discharges 
  4. Late Live Discharges 
  5. Burdensome Transitions (Type 1) – Live Discharges from Hospice Followed by Hospitalization and Subsequent Hospice Readmission 
  6. Burdensome Transitions (Type 2) – Live Discharges from Hospice Followed by Hospitalization with the Patient Dying in the Hospital 
  7. Per-beneficiary Medicare Spending 
  8. Skilled Nursing Care Minutes per Routine Home Care (RHC) Day 
  9. Skilled Nursing Minutes on Weekends 
  10. Visits Near Death 

 

Measures calculated from the CAHPS® Hospice Survey

All eight of the CAHPS® Hospice Survey measures are endorsed under NQF #2651. Details on scores for the CHAPS Hospice Survey measures can be found at: https://hospicecahpssurvey.org/en/scoring-and-analysis/.

Communication With Family

Measure Description:

Multi-item measure. "While your family member was in hospice care..."  P1: “How often did the hospice team keep you informed about when they would arrive to care for your family member?”  P2: “How often did the hospice team explain things in a way that was easy to understand?” P3: “How often did the hospice team listen carefully to you when you talked with them about problems with your family member’s hospice care?” P4: “How often did the hospice team keep you informed about your family member’s condition?” P5: “How often did the hospice team listen carefully to you? P6: "How often did anyone from the hospice team give you confusing or contradictory information about your family member’s condition or care?"

 

Note: All items have response options of “Never”, “Sometimes”, “Usually”, “Always.”

Numerator Statement:

CAHPS® Hospice Survey measures are calculated using top-box scoring. The top-box score refers to the percentage of caregiver respondents that give the most positive response. For questions P1 through P5 in this measure, the top box numerator is the number of respondents who answer “Always.” For question P6, the top box numerator is the number of respondents who answer “Never.” Top box scores for each survey question within the measure are adjusted for mode of survey administration (at the individual respondent level) and case mix (at the hospice level), and then averaged to calculate the overall hospice-level measure score.

Denominator Statement:

The top box denominator is the number of respondents who answer at least one question in the multi-item measure (i.e., one of P1 through P6).

Exclusions:

The hospice patient is still alive -The decedent’s age at death was less than 18   -The decedent died within 48 hours of his/her last admission to hospice care -The decedent had no caregiver of record -The decedent had a caregiver of record, but the caregiver does not have a U.S. or U.S. Territory home address -The decedent had no caregiver other than a nonfamilial legal guardian -The decedent or caregiver requested that they not be contacted (i.e., by signing a no publicity request while under the care of hospice or otherwise directly requesting not to be contacted) -The caregiver is institutionalized, has mental/physical incapacity, has a language barrier, or is deceased -The caregiver reports on the survey that he or she “never” oversaw or took part in decedent’s hospice care

Measure Type:

Outcome

 

Getting Timely Help

Measure Description:

Multi-item measure P1: “While your family member was in hospice care, when you or your family member asked for help from the hospice team, how often did you get help as soon as you needed it?” P2: “How often did you get the help you needed from the hospice team during evenings, weekends, or holidays?”

 

Note: Both items have response options of “Never”, “Sometimes”, “Usually”, “Always.”

Numerator Statement:

CAHPS® Hospice Survey measures are calculated using top-box scoring. The top-box score refers to the percentage of caregiver respondents that give the most positive response. The top box numerator is the number of respondents who answer “Always.” Top box scores for each survey question within the measure are adjusted for mode of survey administration (at the individual respondent level) and case mix (at the hospice level), and then averaged to calculate the overall hospice-level measure score.

Denominator Statement:

The top box denominator is the number of respondents who answer at least one question in the multi-item measure (i.e., one of P1 or P2).

Exclusions:

The hospice patient is still alive -The decedent’s age at death was less than 18 -The decedent died within 48 hours of his/her last admission to hospice care -The decedent had no caregiver of record -The decedent had a caregiver of record, but the caregiver does not have a U.S. or U.S. Territory home address -The decedent had no caregiver other than a nonfamilial legal guardian   -The decedent or caregiver requested that they not be contacted (i.e., by signing a no publicity request while under the care of hospice or otherwise directly requesting not to be contacted) -The caregiver is institutionalized, has mental/physical incapacity, has a language barrier, or is deceased -The caregiver reports on the survey that he or she “never” oversaw or took part in decedent’s hospice care

Measure Type:

Outcome

 

Treating Patient With Respect

Measure Description:

Multi-item measure P1: “While your family member was in hospice care, how often did the hospice team treat your family member with dignity and respect?” P2: “While your family member was in hospice care, how often did you feel that the hospice team really cared about your family member?

 

Note: All items have response options of “Never”, “Sometimes”, “Usually”, “Always.”

Numerator Statement:

CAHPS® Hospice Survey measures are calculated using top-box scoring. The top-box score refers to the percentage of caregiver respondents that give the most positive response. For both questions in this measure, the top box numerator is the number of respondents who answer “Always.” Top box scores for each survey question within the measure are adjusted for mode of survey administration (at the individual respondent level) and case mix (at the hospice level), and then averaged to calculate the overall hospice-level measure score.

Denominator Statement:

The top box denominator is the number of respondents who answer at least one question in the multi-item measure (i.e., one of P1 or P2).

Exclusions:

The hospice patient is still alive -The decedent’s age at death was less than 18 -The decedent died within 48 hours of his/her last admission to hospice care -The decedent had no caregiver of record -The decedent had a caregiver of record, but the caregiver does not have a U.S. or U.S. Territory home address -The decedent had no caregiver other than a nonfamilial legal guardian -The decedent or caregiver requested that they not be contacted (i.e., by signing a no publicity request while under the care of hospice or otherwise directly requesting not to be contacted) -The caregiver is institutionalized, has mental/physical incapacity, has a language barrier, or is deceased -The caregiver reports on the survey that he or she “never” oversaw or took part in decedent’s hospice care

Measure Type:

Outcome

 

Emotional And Spiritual Support

Measure Description:

Multi-item measure P1: “While your family member was in hospice care, how much emotional support did you get from the hospice team?”   P2: “In the weeks after your family member died, how much emotional support did you get from the hospice team?” P3: “Support for religious or spiritual beliefs includes talking, praying, quiet time, or other ways of meeting your religious or spiritual needs. While your family member was in hospice care, how much support for your religious and spiritual beliefs did you get from the hospice team?”

 

Note: All items have response options of “Too little”, “Right amount”, “Too much.”

Numerator Statement:

CAHPS® Hospice Survey measures are calculated using top-box scoring. The top-box score refers to the percentage of caregiver respondents that give the most positive response. For all questions in this measure, the top box numerator is the number of respondents who answer “Right amount.” Top box scores for each survey question within the measure are adjusted for mode of survey administration (at the individual respondent level) and case mix (at the hospice level), and then averaged to calculate the overall hospice-level measure score.

Denominator Statement:

The top box denominator is the number of respondents who answer at least one question in the multi-item measure (i.e., one of P1 through P3).

Those who answer “Too much” are not included in measure scoring.

Exclusions:

The hospice patient is still alive -The decedent’s age at death was less than 18 -The decedent died within 48 hours of his/her last admission to hospice care -The decedent had no caregiver of record -The decedent had a caregiver of record, but the caregiver does not have a U.S. or U.S. Territory home address -The decedent had no caregiver other than a nonfamilial legal guardian -The decedent or caregiver requested that they not be contacted (i.e., by signing a no publicity request while under the care of hospice or otherwise directly requesting not to be contacted) -The caregiver is institutionalized, has mental/physical incapacity, has a language barrier, or is deceased -The caregiver reports on the survey that he or she “never” oversaw or took part in decedent’s hospice care

Measure Type:

Outcome

 

Help For Pain And Symptoms

Measure Description:

Multi-item measure P1: “Did your family member get as much help with pain as he or she needed?” P2: “How often did your family member get the help he or she needed for trouble breathing?” P3: “How often did your family member get the help he or she needed for trouble with constipation?” P4: “How often did your family member receive the help he or she needed from the hospice team for feelings of anxiety or sadness?”

 

Note: P1 has response options of “Yes, definitely”, “Yes, somewhat”, and “No.”

 

Note: P2, P3, and P4 have response options of “Never”, “Sometimes”, “Usually”, “Always.”

Numerator Statement:

CAHPS® Hospice Survey measures are calculated using top-box scoring. The top-box score refers to the percentage of caregiver respondents that give the most positive response. For question P1, the top box numerator is the number of respondents who answer “Yes, definitely.” For questions P2, P3 and P4, the top box numerator is the number of respondents who answer “Always.” Top box scores for each survey question within the measure are adjusted for mode of survey administration (at the individual respondent level) and case mix (at the hospice level), and then averaged to calculate the overall hospice-level measure score.

Denominator Statement:

The top box denominator is the number of respondents who answer at least one question in the multi-item measure (i.e., one of P1 through P4).

Exclusions:

The hospice patient is still alive -The decedent’s age at death was less than 18 -The decedent died within 48 hours of his/her last admission to hospice care -The decedent had no caregiver of record -The decedent had a caregiver of record, but the caregiver does not have a U.S. or U.S. Territory home address -The decedent had no caregiver other than a nonfamilial legal guardian -The decedent or caregiver requested that they not be contacted (i.e., by signing a no publicity request while under the care of hospice or otherwise directly requesting not to be contacted) -The caregiver is institutionalized, has mental/physical incapacity, has a language barrier, or is deceased -The caregiver reports on the survey that he or she “never” oversaw or took part in decedent’s hospice care

Measure Type:

Outcome

 

Training Family To Care For Patient

Measure Description:

Multi-item measure P1: Did the hospice team give you the training you needed about what side effects to watch for from pain medication? P2: Did the hospice team give you the training you needed about if and when to give more pain medicine to your family member? P3: Did the hospice team give you the training you needed about how to help your family member if he or she had trouble breathing? P4: Did the hospice team give you the training you needed about what to do if your family member became restless or agitated? P5: Side effects of pain medicine include things like sleepiness. Did any member of the hospice team discuss side effects of pain medicine with your or your family member?

Numerator Statement:

CAHPS® Hospice Survey measures are calculated using top-box scoring. The top-box score refers to the percentage of caregiver respondents that give the most positive response. For all questions in this measure, the top box numerator is the number of respondents who answer “Yes, definitely.” Top box scores for each survey question within the measure are adjusted for mode of survey administration (at the individual respondent level) and case mix (at the hospice level), and then averaged to calculate the overall hospice-level measure score.

Denominator Statement:

The top box denominator is the number of respondents who answer at least one question in the multi-item measure (i.e., one of P1 through P5). Scores are calculated only among those respondents who indicate that their family member received hospice care at home or in an assisted living facility.

Exclusions:

The hospice patient is still alive -The decedent’s age at death was less than 18 -The decedent died within 48 hours of his/her last admission to hospice care -The decedent had no caregiver of record -The decedent had a caregiver of record, but the caregiver does not have a U.S. or U.S. Territory home address -The decedent had no caregiver other than a nonfamilial legal guardian -The decedent or caregiver requested that they not be contacted (i.e., by signing a no publicity request while under the care of hospice or otherwise directly requesting not to be contacted) -The caregiver is institutionalized, has mental/physical incapacity, has a language barrier, or is deceased -The caregiver reports on the survey that he or she “never” oversaw or took part in decedent’s hospice care

Measure Type:

Outcome

 

Rating Of This Hospice

Measure Description

Individual survey item asking respondents: "Using any number from 0 to 10, where 0 is the worst hospice care possible and 10 is the best hospice care possible, what number would you use to rate your family member’s hospice care?" Response options are on a 0-10 rating scale, with 0=Worst hospice care possible and 10=Best hospice care possible

Numerator Statement:

The top box numerator is the number of respondents in the hospice who answer “9” or “10.” Top box scores for the measure are adjusted for mode of survey administration (at the individual respondent level) and case mix (at the hospice level) to calculate the overall hospice-level measure score.

Denominator Statement:

The top box denominator is the total number of respondents in the hospice who answered the item.

Exclusions:

The hospice patient is still alive -The decedent’s age at death was less than 18 -The decedent died within 48 hours of his/her last admission to hospice care -The decedent had no caregiver of record -The decedent had a caregiver of record, but the caregiver does not have a U.S. or U.S. Territory home address -The decedent had no caregiver other than a nonfamilial legal guardian -The decedent or caregiver requested that they not be contacted (i.e., by signing a no publicity request while under the care of hospice or otherwise directly requesting not to be contacted) -The caregiver is institutionalized, has mental/physical incapacity, has a language barrier, or is deceased -The caregiver reports on the survey that he or she “never” oversaw or took part in decedent’s hospice care

Measure Type:

Outcome

 

Willing To Recommend This Hospice

Measure Description:

Individual survey item asking respondents: “Would you recommend this hospice to your friends and family?”

Note: This item has response options of “Definitely no”, “Probably no”, “Probably yes”, and “Definitely yes.”

Numerator Statement:

The top box numerator is the number of respondents in a hospice program who responded “Definitely yes.” Top box scores for the measure are adjusted for mode of survey administration (at the individual respondent level) and case mix (at the hospice level) to calculate the overall hospice-level measure score.

Denominator Statement:

The top box denominator is the total number of respondents in the hospice that answered the item.

Exclusions:

The hospice patient is still alive -The decedent’s age at death was less than 18 -The decedent died within 48 hours of his/her last admission to hospice care -The decedent had no caregiver of record -The decedent had a caregiver of record, but the caregiver does not have a U.S. or U.S. Territory home address -The decedent had no caregiver other than a nonfamilial legal guardian -The decedent or caregiver requested that they not be contacted (i.e., by signing a no publicity request while under the care of hospice or otherwise directly requesting not to be contacted) -The caregiver is institutionalized, has mental/physical incapacity, has a language barrier, or is deceased -The caregiver reports on the survey that he or she “never” oversaw or took part in decedent’s hospice care.

Measure Type:

Outcome

Hospice Quality Reporting Program Archives

Page Last Modified:
06/24/2022 02:35 PM