Reporting : Preparing for > Explain the Hospice lnformation Set - PDF document

4/7l2OL4 Objectives Hospice Quality Reporting : Preparing for > Explain the Hospice lnformation Set (HlS) HIS > Explain the regulatory authority and requirements for HIS reporting > Describe the HIS quality reporting measures Diane M. Datz, RN, MA > ldentify where to capture HIS data in the HealthCare ConsultLink Patient record 888-258-l 894 > Develop processes to extract HIS data and record in the HIS report What is Hospice lnformation HIS 2014 Data Submission Set Reporting > 2014 HIS submission begins July I , 2014 ) Hospice Quality Reporting Program is > Two HIS reports for each patient: admission mandated by the 2010 Affordable Care Act report and discharge report > Currently a "pay-for-reporting" system, not a r HIS data collection training sessions were "pay-for-performance" system held on February 4 & 5, and are available on CMS website (see Resources at end of > Performance level is not a factor in s lides) determining reimbursement > HIS technical training (with additional ) HIS is a snapshot in time. lt does not reflect instruction) begins in May 2014 the Pt's status throughout their hospice > Data collection and report for CY 2014 admission. effects reimbursement for FY 2016 Penalty for Non-Report Hospice lnformation Set > All Medicare hospice providers with active > Previous HQR Structural Measure and NQF CNN number (provider number) must report 0209 have been eliminated > Hospices awaiting certification will.be > 20'14 will begin collection of new data expected to have HIS processes in place at > Need a new account for HIS; HQR account is the time of their initial survey for deemed no longer operational statu s > Data will be used in determining future > 2% reduction in market basket for FY 2016 if non-report reimbursement models > Must submit both reports (admit and discharge) for all admissions

4lu2OL4 Hospice lnformation set...cont. Hospice lnformation Set...cont. > Hospice lnformation set (HlS) will collect data > HIS (Hospice lnformation Set) rs : on seven new measures . Set of data elements endorsed by National Quality " NQF l6l7 Patients Treated with an Opioid who are Forum Given a Bowel Regimen . Used to calculate 7 quality measures . NQF I 634 Pain Screening . A standardized mechanism for abstracting data . NQF I 637 Pain Assessment from the medical record " NQF I 638 Dyspnea Treatment > HIS is ,of : " NQF I 639 Dyspnea Screening . A Pt assessment tool " NQF I 641 Treatment Preferences " NQF I 647 Beliefs/Values Addressed (if desired by . Will not be administered to Pt/familyi PCC PO HlS...cont. HIS...cont. > Required to submit two HIS records for each > Submit admission and discharge data for admission: ALL Pts regardless of: . HIS-Admission record (45 data elements) . Payor source (Mcr, MK, private payor) . Contains administrative data about ft .ftage . Contains clinical items to calculate the 7 quality . Location where Pt receives services: home, measu res . HIS-Discharge record (1 5 data elements) NF, ALF, in-Pt ' Contains limited set of administrative ltems for " lf Pt is a transfer ft identification . Previous revocation or discharge . Contains discharge information used to determine exclusions for quality measures (i.e. LOS) Ad m i n istrative ! nformation HlS...cont. I Submitted electronically (no paper > Admission date is date of EOB to your hospice, for this benefit period transm i ssion) > Discharge date is date Pt leaves your r Admit and discharge date may be'the same ) Submitted on an ongoing basis hospice . Have 'l 4 calendar days from admit to complete HIS- > Admit and discharge can be the same day Admit records > Leave unknown Pt information blank . Have 7 calendar days from discharge to complete r Pt setting prior to admission may not HIS-Discharge records change with hospice admission i.e. LTCF, " Have 30 calendar days from Admit or Discharge to submit HIS records to CMS home

4/7/20L4 CPR Preference CPR Preference...cont. r HIS: Was the Pt/responsible party asked about > SCENARIO: Pt admitted 08101 12014. preference regarding use of CPR? 08101 12014 clinical note states "Talked w/ Pt ) HIS: Date the Pt was first asked... about DNR status. Pt is not sure and wants to > Must ask Pt preferences even if they are recorded discuss this further w/ family." on referral documentation - ft may make new decision w/ hospice admit. > 08105 12014 Clinical note states "Discussed DNR status, DNR signed." r Orders for "DNR" do not meet the criteria for ' discussion of Pt preferences. > For HlS, what is the date the Pt was first > HIS documents discussion w/ ft, not the Pt's asked about CPR preferences? decision. Date of conversation is not effected by . o8l01 12014 Pt changing her/his mind during subsequent " Subsequent conversation does not impact the HIS conversations. (Snapshot in time.) CPR Preference...cont. Other Life-Sustain ing Preferences r HIS: Was the Pt/responsible parw asked about > Pt admitted 08/01 /2014 Clinical record life-sustaining preferences cithei than CPR? r HIS: Date the Pt was first asked... documents DNR is in effect, dated ) Must ask Pt preferences even if they are recorded 0711s12013. on referral dbcumentation. > Does this meet the burden for HIS discussion? r Conversation can be initiated bv anv hosoice staff - who will do this for your agency? ' > What would need to be done to meet the > Where will you record this data in the Pt's record? burden? (Conversation to verify DNR status.) > CMS does not speciflz what "other" discussion is applicable. You will need to define this and teach your staff what and where to document. i.e. vent, dialysis, tube feedings, blood, antibiotics, lVs Other Life-Sustaining Hospitalization Preferences... cont. ) HIS: Was the Pt/responsible party asked about > SCENARIO: Pt admitted 06123 12014. Clinical preference regarding hospitalization? record documents "Discussed Pt's'views re: ) HIS: Date Pt was first asked... antibiotics. Pt does not know what ife wants, > Must ask Pt preferences even if they are wants to think about it." recorded on referral documentation. > Clinical note 06/30/2014 "pt srates she wishes to have antibiotics if needed." r Conversation may be initiated by any hospice ) What is the date Pt was first asked about staff. antibiotics? > Who will ask, what will they ask, where will it . 0612312O14 be documented? . Pt's subsequent decision does not impact HlS.

4/L/2014 Spiritual/ Existentiil Concerns Active Diagnosis r HIS: Was the Pt/responsible party asked about > Record the Pt's principle diagnosis, the diagnosis that most contributes to spiritual/existential concerns? HIS: Date Pt was first asked... the Pt's terminal condition. ) Documentation of evidence of a discussion. > Determined by the Medical Director in Clinical documentation of Pt's religious collaboration with the lDT. preference does not meet the standard. > Diagnosis code must match ICD-9/10 ) Ptlresponsible party may refuse to discuss. > Three choices: > There is no comprehensive list of existential . Cancer questions/concerns. How will you " Dementia/Alzheimer's define/document this? . None of the above Pain Screen Pain Screen...cont. > HIS: Was the Pt screened for pain? ) Report score at the time of the assessment. ) HIS: Date for screening > If a range is given during the screen, ) HIS: Pain severity - for HIS reporting, score is. document the highest level of pain. converted to none, mild, moderate, severe, or r Clinical judgment can be used to document not rated severity of pain if screening tool does not > HIS: Type of standardized pain screening tool provide. ) Must use a standardized test for screening. > Screen tool may not be required if Pt reports Reported on HIS as numeric, verbal, visual, she/he is not in pain and appears to be staff observation, or none used. comfortable. Pain Screen...cont. Pain Screen...cont. > SCENARIO: Clinical note states "Pt r SCENARIO: Clinical record states "Pt pain free drowsy, appears comfortable.". now, reports abdominal pain rated 4-5 through the night." > ls this a pain screen? Yes. > What is the pain screen for this screen? "Although there is no standardized . 4-5 (reported in HIS as "moderate" tool, it is clear the clinician did an " HIS records the greater pain when a range is assessment. reported