Current Measures

The Comprehensive Assessment at Admission (CBE #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

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, and (Day 3) the day two days prior to death.

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.

Patients are excluded from the denominator if:

• They did not expire in hospice care as indicated by the 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.

The Hospice Care Index (HCI) captures care processes occurring throughout the hospice stay, between admission and discharge. The HCI is a single measure comprising of 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.

The hospice patient is still alive.

The decedent’s age at death was less than 18 years. 

The decedent died within 48 hours of his/her last admission to hospice care.

The decedent had no caregiver of record, or a caregiver of record who is a nonfamilial legal guardian. 

The decedent’s caregiver of record does not have a U.S. or U.S. Territory home address. 

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 the decedent’s hospice care. 

Multi-item measure that assesses how often family caregivers reported that the hospice team:

• Kept them informed about when they would arrive to care for their family member
• Explained things in a way that was easy to understand
• They listened carefully to them when they talked about problems with their family member’s hospice care
• Kept them informed about their family member’s condition
• Listened carefully to them
• Gave them confusing or contradictory information about their family member’s condition or care (original survey only; this item was removed from the revised survey)

Multi-item measure that assesses how often family caregivers reported that:

• They got help as soon as they needed it, when they asked the hospice team for help
• They got the help they needed from the hospice team during evenings, weekends, or holidays

Multi-item measure that assesses how often family caregivers reported that:

• The hospice team treated their family member with dignity and respect
• They felt that the hospice team really cared about their family member

Multi-item measure that assesses how much of the following family caregivers reported:

• Emotional support from the hospice team while their family member was in hospice care
• Emotional support from the hospice team in the weeks after their family member died
• Support from the hospice team for their religious or spiritual beliefs 

Multi-item measure that assesses whether family caregivers reported that their family member got as much help with pain as needed, and how often their family member got needed help for:

• Trouble breathing
• Trouble with constipation
• Feelings of anxiety or sadness

Multi-item measure that assesses whether family caregivers reported that the hospice team:

• Provided care that respected their family member’s wishes
• Made an effort to listen to the things that mattered most to them or their family member.

In the original version of the survey, this is a multi-item measure that assesses whether family caregivers reported the hospice team gave them the training they needed about:

• Side effects to watch for from pain medicine
• If and when to give more pain medicine
• How to help if their family member had trouble breathing
• How to help if their family member became restless or agitated.

In the revised survey, this is an individual survey item hat assesses whether family caregivers reported that the hospice team taught them how to care for their family member, including how to care for family members who need pain medicine, have trouble breathing, are restless or agitated, or have other care needs.

For both the original and revised survey, scores are calculated only among those respondents who indicate that their family member received hospice care at home or in an assisted living facility.

For the revised survey, those who answer “I did not need this teaching” are not included in measure scoring.