The U.S Centers for Medicare & Medicaid Services (CMS) intends a forthcoming quality reporting tool to inform patient care planning, initial assessments and periodic reassessments, the agency told Hospice News.

The agency is in the process of developing the Hospice Evaluation and Assessment Reporting Tool (HEART), a mandatory new comprehensive quality reporting tool that will replace the current Hospice Item Setmeasures. CMS plans to test a prototype in 2020.

The hospice assessment tool will be used by hospice clinical staff to establish baseline health information for all patients enrolled in hospice care and be used depending on the patients’ needs in whole or in part to reassess patients as their care needs change. Hospice clinical staff during visits will administer the assessment tool, include a specified series of questions and tests.

“While it must be recognized that hospice care differs from other post-acute care (PAC) settings, there is a need to create a comprehensive assessment instrument for hospice care to align with other [PAC] settings, where feasible and practical,” a CMS representative told Hospice News. “As such, objectives of a comprehensive assessment instrument must include the ability to establish goals of care that embrace the individual’s values and preferences, and are consistent with a person-centered approach that values the person and caregiver in the care continuum with an emphasis on physical, psychosocial, spiritual, and emotional support.”

In the long term, CMS will likely use the tool to inform new payment models, according to the agency.

As with other mandatory CMS quality reporting programs, hospices could see payment reductions of up to 2% for failing to report HEART data after the tool and associated requirements are finalized. 

CMS has delayed release of the tool because the agency switched to a different vendor midstream. The agency and its vendor, ABT Associates, are actively seeking comment from hospice providers about how the tool can best meet their reporting needs while trying to avoid excess regulatory burden. 

“This would be completely new for providers. Ideally it would be an assessment that would be embedded in a paper system or an electronic medical record, from which the hospice would extract the data and then submit it to CMS,” said Jennifer Kennedy, senior director, regulatory and quality. “There intent would be to use the information for future quality measure development and possibly for future payment reform.”

In a 2018 pilot test in nine hospice sites CMS examined using HEART to collect data on admission and discharge assessments, (60 day) interim assessments, as well as incorporating a standard of practice checklist, and assorted other clinical data that the agency expects could be used to develop new quality measures. 

CMS considered including an interim assessment for patients who are imminently dying, but pilot testing results indicated that hospices needed to focus their efforts on supporting the patient and family at the end of life. CMS is reconsidering inclusion of that requirement, the agency said.

Though when finalized HEART would replace HIS data, hospices would still be responsible for reporting other data the agency requires such as through the Hospice Quality Reporting Program and the Consumer Assessment of Healthcare Providers and Systems surveys. 

“Ideally [HEART] would be an assessment that embedded in a paper system or an electronic medical record, from which the hospice can extract the data that would then be submitted to CMS,” Kennedy told Hospice News. “CMS is very interested in developing a tool that is meaningful in terms of producing data but also not burdensome to the provider or the patient and family.” 

For the remainder of 2019, CMS is gathering information and hosting listening with members from national organizations that included National Hospice and Palliative Care Organization (NHPCO), National Association of Home Care and Hospice (NAHC), Visiting Nurses Association of America (VNAA), and National Partnership for Hospice Innovation (NPHI), as well as engaging stakeholders in special open door forums, conducting expert interviews, and convening a Technical Expert Panel in the Fall.

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