CAHPS Hospice Survey Participation Exemption

The Participation Exemption for Size Form for the calendar year (CY) 2022 CAHPS Hospice Survey data collection and reporting requirements is now available. Hospices that served fewer than 50 survey-eligible decedents/caregivers in CY 2021 (January 1, 2021 through December 31, 2021 [or from assignment of CCN]) can apply for an exemption from participation in the CAHPS Hospice Survey for CY 2022.

To view or complete the 2022 Participation Exemption for Size Form, please click here. The Participation Exemption for Size Form will be available to complete and submit online until December 31, 2022.

Please note, exemptions on the basis of size are active for one year only. If a hospice continues to meet the eligibility requirements for this exemption in subsequent years, the organization will need to again request the exemption.

If a hospice has questions regarding the Participation Exemption for Size process or how to complete the Participation Exemption for Size Form, please contact the CAHPS Hospice Survey Project Team: hospicecahpssurvey@hsag.com or 1-844-472-4621.

CAHPS Hospice Survey Participation Exemption

The Participation Exemption for Size Form for the calendar year (CY) 2022 CAHPS Hospice Survey data collection and reporting requirements is now available. Hospices that served fewer than 50 survey-eligible decedents/caregivers in CY 2021 (January 1, 2021 through December 31, 2021 [or from assignment of CCN]) can apply for an exemption from participation in the CAHPS Hospice Survey for…

Hospice Star Rating, Updated HCI Provider Preview Reports, and HQRP Tip Sheets

A Centers for Medicare & Medicaid Services’ (CMS) webinar on the CAHPS hospice star rating on December 16, 2021 revealed additional detail about the rating, which will be publicly reported on Care Compare beginning in August 2022. CMS is calling this star rating the “Family Caregiver Survey Rating Summary Star” and it will range from one star (worst) to five stars (best).

CMS will calculate nine CAHPS Hospice Star Ratings: one for each of the eight publicly reported CAHPS Hospice measures and a Family Caregiver Survey Rating, which is a summary star rating that combines the star ratings of the eight family caregiver experience measures. Only the CAHPS Hospice Summary Star Rating will be publicly reported on Care Compare and only those hospices with 75 or more completed surveys over the reporting period will have their star rating publicly reported. The rating will be updated every other quarter (every 6 months). CMS is using the February 2022 and May 2022 Care Compare refresh period as a “dry run”. This allows hospices to see their star ratings and what the summary star rating would be if it were to be posted on Care Compare.

Again, CMS will not post the Star Rating on Care Compare until August 2022. Hospices can see their first “dry run” ratings in their CMS Preview Report that became available in November 2021. This is an “on demand” report so it does not automatically appear in the CASPER folder. Hospices need to run the report from the “Hospice Quality Reporting Program” report category. The reporting period for the dry run is October 1, 2018 – December 31, 2019; July 1, 2020 – March 31, 2021. More information about how to access the Star Rating Preview Report is found in the Hospice Quality Reporting Measure Specifications User’s Guide.

During the webinar, CMS explained the calculation of the star rating, which is similar to calculations CMS uses in other quality reporting programs. Top-box scores, the proportion of respondents who gave the most favorable response(s) for each of the CAHPS Hospice Survey measures that are publicly reported, are used and adjusted for the case mix of the hospice and mode of survey administration. CMS intended with the calculation to have maximal differentiation between the star categories and to have minimal differentiation of hospices within the star category making the star rating more meaningful. Detailed information regarding the calculation can be found in the CAHPS Star Rating Technical Notes.

A little more than 2000 hospices met the eligibility criteria to be assigned a star rating for the dry run period. This is not an overwhelming majority of hospices so it is possible there are pockets where only some of the hospices will have a publicly reported Star Rating which may make comparison among hospices confusing. Approximately 90 percent of Medicare beneficiaries enrolled in hospice in 2020 were enrolled in a hospice that does have a Star Rating during the dry run.

The slides and recording of the December 16 webinar will also be available soon on the CMS Hospice Quality Reporting webpage. Additionally, NAHC is developing a resource for providers which will be available at the beginning of 2022.

HCI UPDATE
Due to an issue identified with the national averages and percentile calculations for the Hospice Care Index (HCI) measure, CMS revised the data for the HCI Preview Reports. Hospices are able to access these revised reports via the Hospice Quality Reporting Program category in their CASPER folders now.

CMS is targeting the May 2022 refresh for the inaugural public display of the HCI and Hospice Visits in the Last Days of Life (HVLDL) claims-based measures. The eight quarters of claims data used to calculate these measures for a May 2022 refresh would include Q2 2019–Q4 2019 and Q3 2020–Q3 2021. CMS is also planning to provide annual updates to the claims-based measures in November 2022 and each following November refresh. Learn more about HCI and HVLDL in the Q&A on Claims-Based Measures downloadable (PDF) located on the Background and Announcements webpage.

HQRP TIP SHEETS
CMS updated the Hospice Quality Reporting Program (HQRP) resources on December 16 by posting two new Tip Sheets

Second Edition HQRP Public Reporting Tip Sheet
HQRP Compliance Tip Sheet_ FY 2022 and Future Years​
The Second Edition HQRP Public Reporting Tip Sheet explains how CMS will handle the impact of the temporary exemption of quality reporting that occurred due to the COVID-19 Public Health Emergency (PHE) in the HQRP going forward and incorporates the changes to the HQRP from the FY 2022 hospice final rule. The HQRP Compliance Tip Sheet_FY 2022 and Future Years provides information on the HQRP, compliance requirements and how to track compliance.

Hospice Star Rating, Updated HCI Provider Preview Reports, and HQRP Tip Sheets

A Centers for Medicare & Medicaid Services’ (CMS) webinar on the CAHPS hospice star rating on December 16, 2021 revealed additional detail about the rating, which will be publicly reported on Care Compare beginning in August 2022. CMS is calling this star rating the “Family Caregiver Survey Rating Summary Star” and it will range from…

MedPAC Recommends 20 Percent Cut to Hospice Aggregate Cap

  • Payment Freeze, Aggregate Cap and Telehealth Visit Reporting Highlighted

Late last week, the Medicare Payment Advisory Commission (MedPAC), an advisory body to the U.S. Congress, verbally approved the following recommendations:

  • For fiscal year (FY) 2023, the Congress should eliminate the update to the 2022 Medicare base payment rates for hospice and wage adjust and reduce the hospice aggregate cap by 20 percent; and
  • The Secretary of Health and Human Services should require that hospices report telehealth services on Medicare claims.

A formal vote will be taken at a January 2022 meeting.

On an annual basis, MedPAC reviews draft policy recommendations for inclusion in its annual Report to Congress: Medicare Payment Policy issued each March. The Commissioners met to discuss a wide array of preliminary recommendations that included discussion of hospice payment and related issues.

The first recommendation is a repeat of recommendations from the previous two reports; MedPAC staff indicated that based on existing analysis they do not believe these changes would negatively impact access to hospice care or willingness or ability of hospice providers to care for beneficiaries.

The second recommendation regarding telehealth services was motivated by the expanded use of telecommunications-based visits during the public health emergency (PHE) and the need to know the extent to which telehealth visits are being conducted and access to care during the PHE.

The National Association for Home Care & Hospice (NAHC) has strongly urged the Centers for Medicare & Medicaid Services (CMS) to begin collection of data related to telecommunications-based visits to ensure more complete knowledge of services that are being provided as part of the hospice benefit.

In arriving at these recommendations MedPAC examined a great deal of data regarding the Medicare hospice program that provides insights into existing hospice payment adequacy as viewed through four separate lenses:

  • Beneficiaries’ access to care, including the supply of providers; use, length of stay, and visits; and marginal profit
  • Quality of care, including findings of the CAHPS Hospice Survey and visits at the end of life – while quality data were not available due to the PHE, there was a slight improvement in the share of patients receiving at least one visit from a nurse or other clinician in last three days of life in 2019. MedPAC also indicated that while in-person visits declined during 2020 that does not necessarily reflect a reduction in quality but more likely was due to the PHE
  • Hospices’ access to capital, including provider entry and financial reports and mergers and acquisition activity – continued growth in the number of for-profit providers (7 percent increase) and continued favorable perspectives on the sector by investors indicates positive access to capital
  • Medicare payments and hospices’ costs, including overall Medicare margins in 2019 and the projected overall Medicare hospice margin in 2022 – the 2019 Medicare hospice margin was 13.4 percent, and four of five provider quintiles average margins of over 10 percent. Non-profit hospices and provider-based hospices generally experience lower margins.

Following are some key data provided during the meeting:

  • Medicare hospice outlays grew to $22.4 Billion in 2020;
  • In 2020, over 5,000 providers served over 1.7 million beneficiaries;
  • The number of hospice providers grew by 4.5 percent during 2020, largely driven by the growth in for-profit hospice providers;
  • Hospice deaths in 2020 increased by 18 percent;
  • The number of decedents using hospice increased by 9 percent;
  • The share of decedents using hospice declined to 47.8 percent in 2020 (from 51.6 percent in 2019;
  • Total number of hospice users increased by 6.6 percent between 2019 and 2020;
  • The number of hospice days increased by 4.9 percent in 2020;
  • During 2020 more hospice patients were cared for at home, in assisted living facilities, and in hospitals, while fewer were cared for in nursing facilities and hospice facilities;
  • Average length of stay increased from 92.5 days in 2019 to 97.0 days in 2020, while the median length of stay remained stable at 18 days;
  • Average in-person visits per week decreased from 4.3 visits in 2019 to 3.5 in 2020, with aide visits experiencing the largest decline, although nursing visits also declined (likely offset to some extent by use of telehealth visits);
  • Marginal profit in 2019 was 17 percent; and
  • During 2019, 19 percent of hospices exceeded the aggregate cap (margin prior to recoupment was 22.5 percent and 10 percent afterward).

While time for general discussion was limited, Commissioners expressed a great deal of interest in this sector, including the status of the Medicare Advantage VBID Hospice Component Model (a CMS demonstration model under which hospice is being covered as part of the MA benefit package), concerns about access to care in rural areas, concerns about the impact of the workforce shortage on hospice care, request for further exploration of live discharges in hospice care, and the degree to which the hospice population has changed and reflects a higher proportion of patients with cognitive disease.

A copy of the slides used during the staff presentation is available HERE.  In the coming days, a copy of the full transcript of the meeting will be posted HERE.

MedPAC Recommends 20 Percent Cut to Hospice Aggregate Cap

Payment Freeze, Aggregate Cap and Telehealth Visit Reporting Highlighted Late last week, the Medicare Payment Advisory Commission (MedPAC), an advisory body to the U.S. Congress, verbally approved the following recommendations, with a formal vote will be taken at a January meeting: For fiscal year (FY) 2023, the Congress should eliminate the update to the 2022 Medicare…

Hospice Quality Reporting Program Update: HIS Timeliness Compliance Threshold Report

Hospices can now access their confidential Quality Measure (QM) reports in CASPER for two new publicly reported measures, Hospice Care Index (HCI) and Hospice Visits in the Last Days of Life (HVLDL).  These two claims-based measures will be publicly reported on Care Compare no sooner than May 2022. Hospices have been anxiously waiting to see…

2021 CAHPS Hospice Survey Training Registration Now Open

The Centers for Medicare & Medicaid Services (CMS) will offer Introduction to the CAHPS Hospice Survey the week of September 20, 2021 and CAHPS Hospice Survey Update Training on September 30, 2021. These training sessions are intended for hospices, survey vendors that participate in the CAHPS Hospice Survey, as well as other interested individuals and organizations. Please…

CMS Open Door Forum Updates Home Health & Hospice

The Centers for Medicare & Medicaid Services (CMS) held a Home Health, Hospice and Durable Medical Equipment (DME) Open Door Forum (ODF) on November 4 where CMS reviewed information and resources it has recently released.  A summary is below. HOME HEALTH CMS provided a high level overview of the provisions of the CY2021 Home Health…

New NAHC Webinar: Future Hospice Quality Reporting Measures

The National Association for Home Care & Hospice will present a new webinar, A Discussion of Future Hospice Quality Reporting Measures, on Thursday, August 20, 2020 from 2:00PM to 3:00PM Eastern Time. REGISTER NOW! The Centers for Medicare & Medicaid Services (CMS) is considering a new claims-based composite quality measure concept, the Hospice Care Index…