Ep.8: What Providers Need to Know About the Hospice Quality Reporting Program
Ep.8: What Providers Need to Know About the Hospice Quality Reporting Program
Dr. Jennifer Kennedy, Vice President of Quality & Standards at CHAP, discusses what CMS's Hospice Quality Reporting Program (HQRP) means for the care continuum as a whole, and the most important things for providers to be aware of.
And you’re listening to Vision, the podcast for leaders and forward thinkers in the care industry. Today, we are gonna discuss CMS’S Hospice Quality Reporting Program, what it means for the care continuum as a whole, and what providers really need to know to tackle this subject. We found the best expert we could, and we’re so excited to have Dr. Jennifer Kennedy, vice President of Quality and Standards at CHAP. Jennifer has quite the impressive resume. She has more than 35 years of experience as a leader and nurse in diverse healthcare settings. She’s worked in hospice and palliative care for more than 20 years. She has a bachelor’s degree in nursing, dual master’s degree in health education and case management, and a doctoral degree in healthcare education and policy. She’s also a certified healthcare compliance professional. On top of all that, Jennifer is the lead for the chap quality team.
She interacts with c m s and their contractors as it relates to hospice, regulatory and quality issues for hospice, home health, home infusion pharmacy, and durable medical equipment. She also collaborates with the Chap Center for Excellence as an education content developer and a faculty member. Jennifer is a member of Ana’s National Palliative Nursing Task Group, and has been honored by the UK’s St. Christopher’s Hospice as a nursing pioneer for their palliative care nursing project. She is a well-known speaker at national and state events, and she teaches graduate healthcare administration courses at the university level. So, wow. Thank you so much for joining us, Jennifer. We’re delighted to have you.
<Laugh>. Thank you so much. We’re so excited to have you on podcast. Before we dive into talking about the program, I know our listeners span the entire care continuum, you know, home care, home Health, hospice. So for folks who think that the Hospice Quality Reporting Program may not affect them because they aren’t in hospice, how do you see this program affecting the care continuum as a whole?
Well, you said the key word there, didn’t you? Continuum. Right. So patients move in and out of different places in that care continuum at any, any given time, depending on what’s happening in their life. So they may be in an inpatient setting and have to come out to post-acute. And eventually, everybody, I i, if there’s a cure for mortality let me know. But everyone is gonna come to a place where, you know, either by the confluence of their diagnoses or, you know, old age itself, they’re gonna come to the end of their life. So part different partners in the continuum work with post-acute partners. Mm-Hmm. <Affirmative> and Hospice is one of those post-acute partners, and it’s really, I think, beneficial. You may not think as a hospital administrator or hospital clinician that you need to know about hospice, but everybody needs to know about hospice because people die for different reasons. You know, either they’ve come to the end of a disease trajectory or, you know, it may be something acute that hospice can step in, help the family with sort of making closure or getting as comfortable as they can with death and bereavement. So I think there’s a lot of benefit for all provider types to understand what hospice can do.
Well, you know, I always say this when I’m, when I’m out and about talking in hospice care, you get really one chance to do it. Right. <Laugh>, there, there’s really not a lot of do-overs. Yes, people do leave hospice a little more frequently than they did, let’s say, 10 years ago, but for the most part, every patient and family coming to hospice care, you’ve got one time, one chance to do it correctly. So, if I were a skilled nursing facility administrator, if I were in the hospital realm, I would wanna partner with a hospice that gets it right and gets it done with high quality every patient every time. So I think that’s the stakeholder here, is that first of all, everyone in the healthcare continuum today in the US really needs to know what each part of that continuum does, right? Because we’re all, you know, essentially theoretically rowing the boat in the same direction, right?
Right. We all want the a patient and I, and I’m going to extend it to the family because hospice in, in hospice, the patient and the family are the unit of care. And I really think that’s what it should be if it’s appropriate in every realm of the continuum. But we want that experience of that patient and family to be the most optimal that it can be, no matter if you’re coming to the emergency room because you burned your hand or you’re in hospice and you’re taking your last breath. So, I, I really feel that it’s important, as I said, for anybody in the healthcare continuum that’s providing care to understand who’s who, and then using information and data available to choose your partners, because you wanna, if you’re doing and, and you’re invested in high quality care provision, then that’s what you want when that person leaves your care.
You know, some people think of quality standards as sort of the antithesis to individualized care, you know, if you always have to do something a certain way, isn’t that, you know, against the idea of, of patient-centered care. So, so how can, how can quality standards really support indiv individualized care instead?
So when I think about standards of practice standards of practice are a level up from regulatory requirements, right? You’ve got your base regulatory, but then you’re, you’re leveling up. You’re going beyond what regulatory requirements state when you’re applying standards of practice, standards of practice guarantee, or they should guarantee if they’re being applied correctly by all members of staff to provide care consistently. And that’s what we’re looking for in good quality cares consistently. But as you mentioned, every patient is different and they have to have individualization based on what their needs are. So you can take a standard of practice, which is above and beyond a regulatory requirement, take it, apply it, and individualize it. You still have that, that basis of consistency, which I think of sort of like a supportive net, if you will that holds that practice in place, which gives you that leadway to go ahead and say, okay, Mrs. Chase, I’m going to, we’re going to individualize your plan of care based on this, this, and this what matters to you and what you want out of this experience.
Yeah, absolutely. You know, regulations are there to say, this is how things are supposed to be done, right? Mm-Hmm. <affirmative>, and what we know with regulation is that sometimes it can be in the grayish area. So what standards can do is provide a little more definition to what is supposed to happen. Mm-Hmm. <Affirmative>, and many times, or most times, standards are based on evidence based practice, which regulatory requirements aren’t necessarily based on. So yeah, I, I, I love standards of practice because they, they level the clinician up mm-hmm. <Affirmative> to go above and beyond what you a absolutely have to do mm-hmm. <Affirmative> as it relates to regulation.
Well, you know, CMS is very invested in making sure that their beneficiary, which they call them beneficiaries, have the optimal experience at the end of life. So, developing measures, moves them in theory and in practice towards obtaining that goal of an optimal experience for the patient at the end of life. So, when C M S, it may seem cumbersome, oh, no, not more measures. Nobody wants more measures, right? But they want hospices to focus on impor performance improvement. Right? But you, you don’t know what you’re doing unless you measure it, right? Mm-Hmm. <affirmative>, and you have to have goals. And in order to measure that, and in order for us to have sort of national consistent data that we can measure from provider A to provider B, we have to have measures put into place, right? So the CAP survey, which has eight measures, is a good, is a really good tool, I think.
I think it has room for improvement. And I C M S is actually working on that right now, but that can measure a patient’s experience, or rather, the caregiver fills it out after the patient’s death. Mm-Hmm. <Affirmative>, but it gives good consistent measurement of certain aspects of the hospice experience, right? Mm-Hmm. <affirmative>, we we now have some clinical measures in place underneath the goodness, it’s escaping my mind. It’ll come to me. We ha we’re measuring things like dyspnea and constipation and pain measurements and all of those things. Again, consistently across providers on a national basis. Once we get to the HOPE assessment tool, which is going to be similar to, let’s say a home health oasis or a nursing facility, MDs tool mm-hmm. <Affirmative> the concept, not the structure or the content, right? Mm-Hmm. <affirmative>, but we’ll get to a place where we’ll, we’ll be able to have more consistent measurement across providers as to outcomes of patients that are actually more drilled down outcomes than we’re getting right now. So that’s for, for we people who dabble into the quality realm, that’s really exciting because we’ll be able to you know, get one or two levels deeper on what is happening in that patient experience. And with the Hope Assessment tool, hopefully we’ll even be able to get some information from the patient themselves. Mm-Hmm. <affirmative>, if they’re if it’s applicable or it’s something that the patient’s capable of doing, we’ll be able to get that data, which we never had before.
Yes, that’s an aspect of it. Mm-Hmm. <Affirmative>, so it would be administered at different time points mm-hmm. <Affirmative> during the hospice experience. Obviously we’re doing it mission now, h i s, that’s the data set. Hospice items said, sorry, it was, I have Friday Brain <laugh>
<Laugh>. But yeah, I mean, this will will really give us more information than we have right now with h i s data. And you’re right. It is a little more in, in time with what’s happening with mm-hmm. <Affirmative> with the entire experience. Right now we do admission and we do discharge. Yeah. So beginning and, and anything that happens in the middle. Well, that’s your guess, <laugh>.
That’s a really great question. I think that c M s is extremely focused on health equity right now. Mm-Hmm. <affirmative>, and I’m not sure how the HOPE assessment tool will tackle health equity on, on its own, but we know that C cms given what they put out in this past year’s wage index roles, not only for hospice, but for home health as well, is they’re looking to develop a structural quality measure just for health equity. So I think they’re at the beginning of the health equity journey, and as they move down that path, I would suspect we’ll see more incorporation of not only data measurement, but of interventions and, and measures that will be applied to different provider types to try to capture information about what is happening related to health equity in any place in CM S’S healthcare continuum.
In the future? Well, I think what I know right now is they have pushed out their intent to consolidate some of the measures that they, you know, that they’ve already developed. They, they have a lot of measures in their playbook, not just for hospice, but for everybody. Right, right. It’s a little daunting to look at ’em. So I think that what they’re trying to do over the next few years is really to shore down you know, the quantity of measures and consolidate some of them so that they’re more patient outcome oriented. And I think that’s one of their primary goals is to shoot for those types of measures mm-hmm. <Affirmative> and to really measure what matters, you know? Mm-Hmm. <Affirmative> you can measure everything and you can say everything’s important, and, but it depends on the perspective.
Right. Right. So, I think in order to you know, sort of push any of their quality initiatives forward, they recognize that they have too much, they have too much to measure. So that’s gonna be one of their things that they’re working on in, in what they call their 2.0 initiatives, is that they’re gonna really be looking at their playbook and shoring down a lot of the measures. And in fact this year, the the measurement applications partnership with N Q F, there’s the, with, it’s called the Muck list that comes out every, I know, right?
December 1st, M u C measures under consideration for all provider types. And they actually had on the muck list this year that they looked at what can, what they can get rid of, reducing burden, if you will. Mm-Hmm. <affirmative> upon not only their beneficiaries, but the providers as well.
But I’m, I’m sure several of our, plenty of our listeners will be happy to hear that some of those are under consideration. We’ve been talking focusing a lot about on C M S but we talked in pre preparation for this episode about how a lot of payers really take their cues from c m s. So what, what can we expect to see from other payers in the future in response to this?
Yeah, that’s a great question, Amanda. I, I think as the continuum moves towards value-based purchasing, and we know that CMS is extremely invested in this, I I think the last info I read was that the CMS trust fund was due to run out in like something like 2026 and that far away, right? So they’re invested in not only high quality care provision for the beneficiaries, but also in cost savings, obviously. So value-based purchasing is the way that they’re pushing care and a lot of other providers are taking their cues from that as well. Mm-Hmm. <affirmative> is that it’s a pay, it, it’s gonna be a pay for performance environment in the future of healthcare. So you have to, as a provider, really focus on meeting metrics that are set by the payer in order to get the above and beyond payment for the performance, essentially.
So when we think about healthcare and not only, you know, hospice quality reporting, all kinds of care provision are really going that way. And I think C M S has always been the ones to sort of set the bar as they are, at least for older adults, they are the number one payer in the United States for care. So plans would be taking their queue modeling any kind of payment reform that they’re going to do after what C M S is doing. And C m s has the track record of doing demonstrations before they actually implement plans. So there is, you know, research and data collection and analysis that goes behind it. They just don’t come in into a room and say, let’s do this and we’ll start it next month. You know, it’s, you know, it’s a four year demonstration. It’s a six year demonstration. Mm-Hmm. <affirmative>. So they, they do have the track record and they do have the data to support it.
It is, it is. And my experience at hospice all these years is that hospice providers don’t like change. So it’s gonna be challenging, and I’m sure it’s challenging to sort of put your arms around this kind of payment system for other providers as well. But I always feel like hospice has been the caboose on the Medicare train. You know, everything comes to hospice after it’s been done here, here, and here in the continuum. So I think that it will be challenging, I think structuring payments in order to make them fair to meet what, you know, market costs are. Mm-Hmm. <Affirmative> to actually provide care. And we know that staffing is a huge issue right now, and paying for staffing is, is really challenging mm-hmm. <Affirmative> out there in today’s healthcare markets. So I think that’s gonna be the biggest is, you know, Kenna Hospice provide care under that model and break eVet. Right. and then, you know, on top of that, meet their quality metrics to get the, the little boost of money that comes with it. Mm-Hmm. <affirmative>. Mm-Hmm. <affirmative>,
You talked a little bit about how hospice organizations will need to meet certain metrics to, you know, achieve the highest possible payout under under this program and under value-based purchasing in general. What can they, what steps can they take now to start preparing?
Well, I think, you know, we have a really, whether you like it or not, we have a good structure. We have the CAPS survey, which, you know, drives you know, drives the, the hospice provider to really look at the different aspects of a patient experience. And that’s really what a plan is going after as well. You know, they, because a plan gets marked highly or not highly based on outcomes not only for provider evaluations, but how will they do with patient evaluations as well? Did they, did the plan, select their providers wisely, right? Mm-Hmm. <Affirmative>. So I think really embracing the measure structure that is in place now and to improve at any moment that you can improve is gonna help set you up in order to be able to function in that type of a model. Right? also, it’s very competitive out there, you know, ho in, in, in some states there’s hundreds and hundreds of hospices, Texas, for example, you know California, they’re saturated with hospice providers.
So it’s, it’s a very competitive market as well. So even if we took value-based purchasing off the table, in order to be competitive and wind referrals and have good word of mouth in your community, you have to perform highly, right? Yeah. So, and now we have stars attached to caps mm-hmm. <Affirmative>. So that’s just another thing that hospices can be working on. If they’re not happy with the outcome of their stars or their CAP scores or their h i s scores, they need to really make an investment not only with finances, but also with human resources to dedicate that, those kinds of resources to quality improvement. You know, I think in my long time in the, in the healthcare arena, the first thing to go when a budget gets cut, education gets paired down, quality gets paired back, and people get here wear these three extra hats, right? <Laugh>,
Mm-Hmm. <Affirmative>. But you know, it, when we’re looking at a value-based purchasing model, you can’t you can’t not consider it just as important as say, like compliance or finance mm-hmm. <Affirmative>, it’s, it’s almost, it’s, those are almost like the, the trifecta triangle in when we’re thinking about healthcare moving forward. So investment in supporting quality initiatives is gonna become key in order for organizations to be successful. Absolutely. And I, I imagine you see this, that same triangle working just as well in any post-acute Absolutely. Organization. Yeah. And when I, when I speak like this, I’m not even just talking about hospice providers, it’s anybody who’s moving towards that value-based purchasing, you know, making sure you’re, em, admitting the right patients at the right time. You have staff to take care of them mm-hmm. <Affirmative>, and that you’re, you know, minding your metrics essentially. Right? not only minding them, but also what’s the plan to improve next month or the next month or after that, you know? Because if you’re in a value-based purchasing situation and you’re not making your metrics that’s gonna hit your bottom line financially. Yeah.
Absolutely. So much of this. Absolutely. I would even say it’s pastime. You know if, if providers out there, doesn’t matter what type you are, haven’t been paying attention to this, this is, you know, as you jump out of the out of the gate from 2022 into 2023, put that on your strategic plan cuz you’re gonna need to, you’re gonna need to, as I said, dedicate resources to the support of quality. Mm-Hmm. <affirmative>.
This <laugh>, right? Yeah. I mean, you know, it’s, it’s, it’s just how it is. And unfortunately, some organizations will, you know get it and they will prepare and they will keep moving their quality needle forward. And some organizations may, they may not succeed and, you know, they may not then be chosen as partners for planner with mm-hmm. <Affirmative> payer plans with referral sources, et cetera. So I think we’re in, we’re, we’re in the beginning of high stakes healthcare, you know, I think it was always sort of high stakes at different topics at different times, but I think we’re really entering a time in healthcare. I’ve never seen anything like this in my time where it’s really high stakes. Yeah. Yeah. I see you nodding your head, Linda. Yeah.
Themselves, right? Yeah. Because you know what, whether you have a star on a public reporting site or you don’t being the best that you can be is going to win you community partners, right? So I would say absolutely spot on, Linda, you should function as if you have stars mm-hmm. <Affirmative>, and that you are consistently trying to improve your stars if you’re not, you know, happy with them. There are metrics that I’m sure you know, are, are followed and looked after closely and on the list for improvement. Adding the concept of stars, I think would be even more incentive for an organization to, to improve.
I agree. I agree. And, and how this is a little off track, but I just wondered about your take on, or should organizations as part of their you know, quality program assess the satisfaction of their employees?
Oh my gosh, yes. Yeah. I mean, I think that, you know, if that goes a hand in glove, knowing what your, your what your patients and your families are happy about, what they’re not happy about is hand in glove with how your employees feel about working at your organization. Yeah. And I wouldn’t say do it every three years. That’s sort of the I think that’s the old school kind of thinking mm-hmm. <Affirmative>, you don’t wanna inundate them with like, how you feeling? How you feeling now?
Yeah. How you feeling today? But you know, you can you know, if you do it annually every 18 months, you know, you do a sort of a formal structured one, but you can do like quick check-ins mm-hmm. <Affirmative> at, at different points, you know, whether you know, great example would be the pandemic is starting <laugh>, you know, let’s see how you’re doing three weeks into the pandemic, right? Mm-Hmm. <Affirmative>, you’re checking the pulse and temperature of your employees ad hoc whether they’re time, time points, or they’re in tandem with maybe something that’s happening in the organization, whether it’s structural change mm-hmm. <Affirmative>, or there’s something happening out in the community that affects your staff. Yeah. So I definitely, I’m a big supporter of employee surveys because particularly as I mentioned before, in these days and times when we are in a huge staffing crisis, right? We have to figure out why the ones who stay, why do they stay? Right? And the ones who are leaving, what is it that we couldn’t give them that they felt they had to leave and go somewhere else? Right?
Staying? I know. What a great idea, <laugh>. Yeah. Yes. I like that idea. You know? Mm-Hmm. <Affirmative>, and really, if you have someone who’s staying and is happy and, and they, you know, told you why mm-hmm. <Affirmative> taking your cues from that, but also in really leveraging them as a stakeholder in your organization to relate to your other staff members is really, I think, like gold. I mean, that’s great. It’s, it’s something that you would want to happen, and if it is happen in your organization, then oh my God, cherish it. Because that doesn’t happen very often. I don’t think
I know on the home care side, hearing from our customers, they’ve by interviewing their staff who are staying, they’ve sometimes even identified competitive advantages they didn’t know they had. And been able to leverage that to, to hire more and, and to find more clients or patients. You know, one of their staff said, I really value this, you know, thing that we do really well here. And they hadn’t really thought of themselves as, as such a leader in the industry at that specific item because they don’t, you know, see so much what’s happening at other agencies. And we’re able to use that to, to recruit better
A absolutely. You know, I, I, I think that we have to really pay attention to stopping right now. We’re at sort of a critical juncture in healthcare staffing where we can learn so much. And, you know, this is a time for organizations to be nimble, flexible about how people work, you know? Mm-Hmm. <Affirmative> we can do different arrangements now. It doesn’t have to be, you know 80 hours every two weeks, you know, this, you know, we can figure out and, and tailor things now to what meets our staff and makes them happy, but also meets our patient and family needs as well. Mm-Hmm. <Affirmative>, right? Mm-Hmm. <affirmative>.
I would just say, you know, be quality committed. You know, no matter where you function in the healthcare continuum, you know, think about your experiences when you have to receive healthcare yourself and how you would want it to go. So if you think about that and you can kind of keep that as your, your focal point mm-hmm. <Affirmative> that’ll help you be a better clinician in providing the care that you provide to patients and families.
I love that. Mm-Hmm. <Affirmative>. Yeah. Absolutely. Well, thank you so very much for taking time outta your day to, to chat with us and to share all your words of wisdom with our audience. I know that everyone will be so be taking notes <laugh> as they listen to this podcast. So thank you so much, Jennifer.
And I’m also best reached on LinkedIn. I’m Amanda Stern Clark there. If you have a story you’d like to share on our podcast we do now have a forum on the site rather than just our, our LinkedIn dms. You can just go to homecare pulse.com/podcast while you’re there. You can listen to any of our previous episodes and you can also find them wherever you listen to your podcasts. Thank you all so much for joining us. We’ll be off for the holidays when our next episode would usually be posted, but we’ll be back two weeks after that.