How can you know you are partnering with high-quality hospice providers? A primer on Hospice Compare and its quality measures

By Dawn Darvalics, PMP, Director of Quality and Education, Care Synergy

It has been almost three years since the Centers for Medicare and Medicaid Services (CMS) launched a useful tool that can help senior care facility operators make good choices about the hospice providers they work with.  Here is a brief primer on the CMS Hospice Compare website, and some perspective on how to best interpret the important data you’ll find there.

The Hospice Compare website allows the public (typically patients, families and hospice referral sources) to easily search for hospices by name or location. You can compare the publicly reported data from up to three hospice providers at a time against each other and against the national average of hospice organizations across the country.

The data is divided into five categories, or tabs, including General Information/Level of Care, Conditions, Location of Care, Family Experience of Care and Quality of Care.

The first category, General Information/Level of Care, defines the four levels of care covered in the Medicare Hospice Benefit.   Senior care facility operators will want to ensure that a hospice partner provides more than routine home care. Offering higher levels of care including Continuous Home Care and General Inpatient Care are important in identifying that hospices appropriately care for patients requiring crisis level of care for short-term management of pain and other symptoms.

Respite Care is another level of care hospices should offer to provide temporary relief to caregivers of terminally ill patients.  The information provided on Hospice Compare will indicate if a hospice provides Routine Home Care and at least one other level of care.  

Data for the second and third categories — Conditions and Locations of Care — are extracted from Medicare claims to show general characteristics of hospice providers. Here you can find the percentages of specific medical conditions a hospice most commonly treats based on patients’ primary diagnoses, such as cancer, dementia, stroke, heart disease, and respiratory disease.

You can also see the breakdown of where a hospice agency provides most care, such as at home, in an assisted living facility, nursing facility, or inpatient hospital or hospice facility. It is important to note here that many hospices will show zero percent for some locations. This does not mean it cannot provide care at those locations. It may only mean it did not do so during the one-year time period the data was pulled from.

Finally, the last two categories are most important to consider. These show the two types of data on quality measures that hospice agencies are now required by federal regulation to submit.

The Family Experience of Care data is a subjective measure of the experience of a patient’s primary caregiver. It comes from the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey, administered by an independent third-party vendor.

The survey asks the primary caregivers of patients who died a variety of questions about their experience with hospice. There are six composite measure scores calculated by the percentage of survey respondents who indicated their hospice team “always”:

1) communicated well

2) provided timely help

3) treated the patient with respect

4) provided emotional and spiritual support

5) provided help for pain and symptoms

6) trained the family to care for the patient 

The data also show what percentage of these caregivers would rate their hospice a 9 or 10 (on a scale of 1-10) and what percentage would “definitely” recommend the hospice agency to friends and family.

If you want to dig a little deeper, there is a link to “view more details about the survey” provided under the Family Experience of Care tab. This will allow you to look more closely at the percentages reported for possible signs of concern. For example, you can see what percentage of survey respondents said a hospice only “sometimes” or “never” treated patients with respect. This number should always be low.

The last category of data is Quality of Care. It shows the percentage of patients who received at least one visit from a registered nurse, a physician, a nurse practitioner, or a physician assistant in the last three days of life. Research has shown that symptom burden is highest and family needs are greatest during the last week of life, making it extremely important for hospices to provide visits during this time.

Also under the Quality of Care tab, you will find scoring on how well hospices are doing when patients are first admitted. These quality measures are based on the Hospice Item Set (HIS) Comprehensive Assessment at Admission. This data point shows the percentage of newly-admitted patients who receive all seven care processes expected by CMS. This includes: asking those patients about their treatment preferences and beliefs and values, checking them for pain and shortness of breath and thoroughly assessing and treating those conditions if needed, and offering treatment for constipation for patients taking opioids.  The website provides the option of drilling down to see the hospice’s score for each of the seven process measures.

You should expect a good hospice partner to receive high scores on this Quality of Care data. It is essentially a straight-forward measure of whether hospice agencies are completing essential care processes or not. 

The Hospice Compare website also provides a link on the home page to a list of the dozens of hospice providers that are terminated or at risk of termination from Medicare. 

And one other great resource to mention: a link to a checklist of questions for families to ask hospice agencies. Senior care facility operators may find many of these questions helpful as well, as they work to ensure the best possible care for their residents facing terminal illness.

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About the Author

Dawn Darvalics, PMP, is Director of Quality and Education at Care Synergy. The Care Synergy network’s five affiliate organizations operate as distinct and independent not-for-profit mission-driven hospice and palliative care organizations while working together to share best practices and serve more Coloradans along the Front Range. The affiliates are The Denver Hospice and Optio Health Services, Halcyon Hospice & Palliative Care, Pathways, Pikes Peak Hospice & Palliative Care, and Colorado Visiting Nurse Association.