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
INCORPORATING HIS INTO QAPI PROGRAMS
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
PAIN AND DYSPNEA ASSESSMENTS
Patients screened for pain and dyspnea during
each nursing visit
Was a standardized pain tool used? Was a comprehensive assessment performed?
TREATMENT FOR PAIN AND DYSPNEA
Patients who c/o pain and dyspnea that receive
treatment
Were new medications and interventions added
REASSESSMENT 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
BOWEL REGIMEN WITH OPIOID USE
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.
TREATMENT PREFERENCES
Patients whose preferences regarding CPR,
hospitalization, and life-sustaining treatments
care
Patients whose documented preferences were not
met or the reason for not following the preferences were documented in the medical record
HOSPICE-LEVEL QUALITY MEASURE REPORT
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
RESOURCES FOR THE HIS
www.cms.gov www.nhpco.org www.ghpco.org
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
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?
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
abuse by Government Accountability Office (GAO)
vulnerable
hospices to audit to ensure charges are correct.
PEPPER can help
– UB-04 claims submitted to Medicare Administrative Contractor (MAC)
and state statistics
(CMS) contracted TMF Health Quality Institute to distribute
Analysis Tool for Hospital Outlier Monitoring (FATHOM) to MACs and Recovery Auditors
– FATHOM can be used to produce a PEPPER
– CMS can direct TMF to respond to external requests – Provided PEPPERS to OIG, DOJ, State Attorneys General
– Uses billing data to create and corroborate investigative leads – Emerging fraud trends:
Laboratory services
Hospital-based services
waste
– Priority areas to monitor/audit
– Available to CEO/Administrator and Compliance Officer
– Review admission process – Meet eligibility criteria
– Initiated by patient – High cost care
– Financial incentives
– Review admission process – Meet eligibility criteria
Living Facility
– Meet eligibility criteria – Appropriate care in ALF – Documentation supports care hours billed
IN:
– Review admission process – Meet eligibility criteria
– Related to terminal illness – Substantiated with documentation – Physician determines
Home Care
– Provide all levels of care – Process to assess needs
– Are data differences due to your area
– Determine audit frequency – Develop improvement plan
– Stop issues before they become problems
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
Challenges and Strategies for Preventing Improper Payments.” June 15,
“Federal Register 64, no. 192, October 5, 1999, 54031-54049. Available at: https://oig.hhs.gov/authorities/doc/hospicx.pdf.