Hospice Quality Reporting Program 2021 Information Gathering Report

The Centers for Medicare & Medicaid Services (CMS) has released the Hospice Quality Reporting Program 2021 Information Gathering Report, which provides information from literature reviews and expert interviews that supports expansion of the hospice quality reporting program. Specific topics include treatment of moderate to severe pain, patient preferences, spiritual care, social needs, medication management, and other topics related to hospice quality.

CMS anticipates expanding the Hospice Quality Reporting Program (HQRP) over the next several years to include additional meaningful quality measures to help consumers make informed decisions when selecting a hospice for end-of-life-support. This expansion includes introducing the Hospice Outcomes & Patient Evaluation (HOPE), and may be introduced for possible hospice use for FY2024, although CMS has not provided a date.

There are only a handful of current measures publicly reported as part of the HQRP.  This is slim compared to other provider types and due in part to the lack of a tool for the HQRP that collects data while care is being delivered to the patient, as the HOPE will do.  The Hospice Information Gathering Report supports the efforts to expand the HQRP by reviewing available resources to inform HOPE development and related quality measures. Technical Expert Panel (TEP) deliberations, in addition to discussions with the HOPE development team, the hospice quality measurement development team, and federal stakeholders, identified areas where additional information could support the HQRP expansion.

This Report provides insight into the specific aspects CMS focused on for each of the topics addressed in the Report – treatment of moderate to severe pain, patient preferences, spiritual care, social needs, medication management, and other topics related to hospice quality – why and what was discovered.  Links to all the resources reviewed are available and hospices may find these helpful for understanding how best to address the issues CMS identified in each of the topic areas.

Among its conclusions, CMS found that evidence supports the current HQRP measures under development for treating moderate to severe pain. In other areas (risk adjustment for neuropathic pain, patient and proxy concordance of patient symptom management preferences, and psychosocial outcomes), CMS found limited evidence for the hospice setting.  However, CMS provided information from other settings to support HQRP activities in these instances.

CMS explored evidence for future potential areas of measure development, such as medication management, finding gaps concerning the reasonable use of medications at the end of life and the engagement of patients and caregivers.  Those interested in the future path of the HQRP and its measures should read this report and investigate some of the tools and resources CMS found to be promising for providing/assisting in providing good quality care to patients.

More information about CMS’ efforts to expand the HQRP can be found in the 2019 Information Gathering Report and the  2020 Information Gathering Report.