HOSPICE ITEM SET HIS I NCORPORATING HIS INTO QAPI P ROGRAMS Track - PowerPoint PPT Presentation

HOSPICE ITEM SET HIS

I NCORPORATING HIS INTO QAPI P ROGRAMS  Track and trend patients’ palliative care and quality of care outcomes, not just on admission but throughout hospice care  Results can be reported based on all teams as well as individual teams. Drill down further to team members  Provide measurable patient outcomes that show strengths and PIP opportunities

P AIN AND D YSPNEA A SSESSMENTS  Patients screened for pain and dyspnea during each nursing visit  Was a standardized pain tool used?  Was a comprehensive assessment performed?

T REATMENT FOR P AIN AND D YSPNEA  Patients who c/o pain and dyspnea that receive treatment  Were new medications and interventions added or adjusted?

R EASSESSMENT WITHIN 24 AND 48 HOURS  Patients that receive a follow-up call or visit within 24 hours of a change in symptom management orders or interventions.  Patients who receive symptom management for pain and dyspnea that achieve an acceptable level within 24 to 48 hours

B OWEL R EGIMEN WITH O PIOID U SE  Patients who are treated with an opioid that are prescribed a bowel regimen or if not, a reason is documented  EMR and Pharmacy reports can provide lists of patients who are prescribed opioids.

T REATMENT P REFERENCES  Patients whose preferences regarding CPR, hospitalization, and life-sustaining treatments other than CPR were documented on the plan of care  Patients whose documented preferences were not met or the reason for not following the preferences were documented in the medical record

H OSPICE -L EVEL Q UALITY M EASURE R EPORT  View HIS data during a specific reporting period  Compare your data to other providers  Available as of December 2016  Log into QIES ASAP and retrieve from CASPER reports

R ESOURCES FOR THE HIS  www.cms.gov  www.nhpco.org  www.ghpco.org

CAHPS

 Caregiver perception of your organization’s performance  Aggregate data related to specific areas of concern, ie: pain medication teaching  Positive feedback  Comparison of your organization to the national/state average for each data point

DRILL DOWN!

 Is there a specific department that consistently has low scores?  Is there a specific team member whose patients’ caregivers consistently report negative feedback?  Is there a specific data point that is consistently lower than the benchmark? (ie: pain medication teaching)  Set your goals at or above the state average

 What other quality measures are there that can be compared against the CAHPS? HIS!  Pain/dyspnea on admission-HIS VS.  Pain/dyspnea symptom management-CAHPS

 PIP – able to show a surveyor that you’ve identified an area for improvement and have come up with a plan  Start a complaint/negative survey process for follow up by management  This can also help drill down for negative trends in specific staff or departments  EDUCATION, EDUCATION, EDUCATION!  Staff don’t always know/understand what they’re being “judged” on

Lauren Ogilvie, PIS VITAS Healthcare 404-843-6533 Lauren.Ogilvie@vitas.com

The Program for Evaluating Payment Patterns Electronic Report PEPPER

Why PEPPER? • Medicare designated as high risk for fraud and abuse by Government Accountability Office (GAO) • Medicare Hospice Benefit identified as vulnerable • Office of Inspector General (OIG) encouraged hospices to audit to ensure charges are correct. PEPPER can help

What is PEPPER? • A single hospice’s claims data report – UB-04 claims submitted to Medicare Administrative Contractor (MAC) • Compares data to national, MAC jurisdiction, and state statistics • Centers for Medicare and Medicaid Services (CMS) contracted TMF Health Quality Institute to distribute

Who Gets PEPPER? • Provider only gets their report • TMF does not provide it to other contractors • TMF DOES provide Access database (First-look Analysis Tool for Hospital Outlier Monitoring (FATHOM) to MACs and Recovery Auditors – FATHOM can be used to produce a PEPPER

External PEPPER Request • CMS direction: – CMS can direct TMF to respond to external requests – Provided PEPPERS to OIG, DOJ, State Attorneys General • Department of Justice: – Uses billing data to create and corroborate investigative leads – Emerging fraud trends: • Medicare Part D Laboratory services • Drug diversion Hospital-based services • Hospice care

PEPPER Access • Compares 3 years of data • Identify trends reflecting possible fraud and waste – Priority areas to monitor/audit • Go to www.PEPPERresources.org – Available to CEO/Administrator and Compliance Officer

TARGET AREAS

Live Discharges • No Longer Terminally Ill – Review admission process – Meet eligibility criteria • Revocations – Initiated by patient – High cost care • Length of Stay (LOS) 61-179 days – Financial incentives

2014 LOS Data

Target Areas • Long LOS – Review admission process – Meet eligibility criteria

2014 LOS Data

Target Areas • Continuous Home Care in Assisted Living Facility – Meet eligibility criteria – Appropriate care in ALF – Documentation supports care hours billed

Routine Home Care IN: • Assisted Living Facility • Nursing Facility • Skilled Nursing Facility – Review admission process – Meet eligibility criteria

Target Areas • Single Diagnosis – Related to terminal illness – Substantiated with documentation – Physician determines • No General Inpatient or Continuous Home Care – Provide all levels of care – Process to assess needs

Next Steps • Review data – Are data differences due to your area • Identify priority areas to monitor/audit – Determine audit frequency – Develop improvement plan • Compliance Officer role – Stop issues before they become problems

Conclusion The Program for Evaluating Payment Patterns Electronic Report summarizes provider- specific data for Medicare services that may be at higher risk for improper Medicare payments. PEPPER can assist providers in identifying areas for improvement

References • Government Accountability Office. “Medicare Fraud, Waste and Abuse: Challenges and Strategies for Preventing Improper Payments.” June 15, 2012. Available at: http://www.gao.gov/new.items/d10844t.pdf . • Department of Health and Human Services/Office of Inspector General. 1999. “Publication of the OIG Compliance Program, Guidance for Hospices, “ Federal Register 64, no. 192, October 5, 1999, 54031-54049. Available at: https://oig.hhs.gov/authorities/doc/hospicx.pdf.