Public Reporting of Quality Data Looms – Are Providers Prepared?
Hospice Compliance Letter, March 2017
As the federal Centers for Medicare and Medicaid Services (CMS) continues its inexorable march toward the long-awaited Holy Grail of publicly reported, comparable quality data on hospices to be posted on its planned “Hospice Compare” website, some new intermediate requirements for data reporting go into effect April 1. CMS’ Hospice Quality Reporting Program (HQRP) is comprised of two principal elements, the Hospice Item Set (HIS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey. HQRP was created in 2010 to promote delivery of high-quality hospice services through required reporting of outcomes from hospice care. Hospices started reporting these data in 2014, and penalties are now up to 2 percent of their annual Medicare reimbursement update for failure to comply with reporting requirements.
The new HIS reporting requirements include seven elements for hospices to capture and report, three for every patient admitted starting April 1 and four for every patient discharged on or after April 1, including level of care and visits by discipline in final seven days of life. These HIS elements will be used to generate two new measures of quality: hospice visits when death is imminent, and hospice and palliative care composite process measure. The Hospice CAHPS 47-question, postdeath survey on experience of care is sent to the identified primary caregiver two months after the patient’s death by an authorized survey vendor with whom the hospice contracts. The eventual public posting of quality data at Hospice Compare, now projected to start in late summer 2017, will offer a decision guide for consumers, data to aid hospices in internal quality improvement efforts and benchmarking with other providers, and information for CMS to use in monitoring care provision, with future annual payment updates tied to how a hospice performs on the reported outcomes measures.
“There is now another process of data gathering and review required of the hospice at the time of discharge,” says Liz Silva, director of home health & hospice at HEALTHCAREfirst. “It can be challenging to accurately extract daily visits by discipline at the time of discharge. Hospices need to be aware of the regulatory deadlines and make sure data pulled by their electronic health record (EHR) vendor are correct. It sounds simple, but it’s not necessarily a straightforward process for every hospice—or every EHR,” she says. At press time, some EHR companies had still not released their updates for April 1. Hospices must include these new HIS items in the XML files they submit to CMS or the records will be rejected, possibly exposing the provider to penalties.
HEALTHCAREfirst Introduces “Solution Suite”
Home Care Technology Report, February 24, 2016
Coordinating the efforts of six different technology vendors may soon be a thing of the past for clients of Springfield, Missouri-based healthcare at home software and services provider HEALTHCAREfirst. The company has assembled all of its products and services into a bundle that it will be calling its “Solution Suite.” The pricing model will change as well, with a single monthly payment for the bundle instead of separate charges for each component.
We spoke with CEO Bobby Robertson about what may be a first-of-its-kind offering.
“This idea has been in the works for a number of years,” he began, “in response to a list of needs we saw. In our space, we compete with software companies, coding companies, billing services companies, analytics companies, and connectivity companies because we offer all of these things too. In the software arena, we have been selling features and functionality. Certainly, we do things better than some others, and some do things better than us. What we realized is that that narrow focus blurs the concept that what we are really supposed to do for our customers is provide a value.
“So we backed up and asked ourselves…What are the most important things that keep our customers up at night?”
Robertson and company decided that it boils down to three issues:
- Profit – HHAs are being squeezed from top and bottom; costs are up, and pay rates are down.
- Regulatory compliance – Auditors are looking over their shoulder all the time, trying to find honest mistakes that they can call fraud and impose monetary penalties.
- Referrals – Reputation within the community has a direct impact on referrals and census.
Robertson outlined the ways “Solution Suite” addresses each of the identified issues.
Elite Team Builds Point-of-Care System for HEALTHCAREfirst
Home Care Technology Report, September 30, 2015
In team sports, if one’s goal is to win regardless of cost, the logical strategy is to assemble a team made up entirely of All-Stars. It worked for George Steinbrenner and the Yankees in the 90’s and several teams have tried out the method since. The most recent organization to do so is not a sports team at all but the Steinbrenner strategy seems to apply in the competitive world of healthcare at home software.
We spoke this week with some of the members of an ad hoc software design team assembled by HEALTHCAREfirst CEO Bobby Robertson. His All-Star team is made up of former NAHC regulatory consultant Mary St. Pierre, former agency owner and Home HealthCare Nurse editor Tina Marrelli, home health IT consultant Suzanne Sblendorio, and Neeley Current, Director of the University of Missouri User Experience Lab. They teamed with 25-year home health software engineer and architect Stan Bell, HEALTHCAREfirst‘s VP of Product Management.
Identifying the Need
After listening to his customers, Robertson decided it was time to modernize his clinical point-of-care product with the latest connectivity tools and updated clinical protocols. Influencing factors in his decision to revise an already successful and popular software module included:
- increasingly aggressive Medicare contractors — MACs, ZPICs, and RACs — who are looking to exploit both egregious and meaningless clinical documentation errors in an effort to root out fraud, waste and abuse;
- a conviction that clinical documents are more accurate when completed in the presence of the patient instead of at the end of the day (or the week);
- the frequent comments heard from field clinicians that point-of-care software more often hinders than promotes the likelihood that documentation will be completed in the patient’s home.
What the All-Stars came up with may very well be a leap forward in technology and ease of use but this is not a product review. The new point-of-care application will not be unveiled until the NAHC meeting at the end of October and released to HEALTHCAREfirst customers shortly after. Rather, this is a study of how some top industry experts collaborated to come up with something potentially newsworthy.