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Hospice Visits in the Last Days of Life

CBE ID
3645
Endorsement Status
E&M Committee Rationale/Justification

When the measure returns for maintenance (5 years), the measure developer should have:

  • Explored the feasibility and utility of adding additional disciplines (e.g., chaplains) and patient preferences (e.g., visit refusal) to the measure;
  • Conducted updated correlation analyses exploring included disciplines with patient/family satisfaction; and
  • Explored, with the developer’s technical expert panel (TEP), the timing and unpredictability of end-of-life events.
1.0 New or Maintenance
1.1 Measure Structure
Previous Endorsement Cycle
Is Under Review
No
Next Maintenance Cycle
Fall 2029
1.6 Measure Description

The proportion of hospice patients who received hospice visits from a Registered Nurse or Medical Social Worker (non-telephonically) associated with the measured hospice entity during at least two of the final three days of life.

Measure Specs
General Information
1.7 Measure Type
1.7 Composite Measure
No
1.3 Electronic Clinical Quality Measure (eCQM)
1.8 Level of Analysis
1.9 Care Setting
1.10 Measure Rationale

This process measure focuses on the provision of consistent professional staff visits during the last three days of life during this time of increased symptom burden. The disciplines included in this measure – registered nurse and medical social worker service visits – were selected not only because they are the focus of CMS’s payment incentive policy for end-of-life visits (the “Service Intensity Add-On”) but also empirical testing found these visits had the highest correlation with CAHPS Hospice scores (Abt, 2020). Additionally, CAHPS hospice ratings were found to be greatest when visits were provided on two of the last three days of life. Two days would seemingly be preferable to one day for providing more supportive services; as to why it would be preferrable to three days, families may prefer at least some privacy during an end-of-life vigil (and not requiring a visit every day of the last three days of life allows greater flexibility for hospice providers to achieve success at this measure).

Citation: Abt (2020). Hospice Visits When Death is Imminent: Measure Validity Testing Summary and Re-Specifications. Retrieved from: https://www.cms.gov/files/document/hqrphospice-visits-when-death-imminent-testing-re-specification-reportoctober-2020.pdf

1.20 Types of Data Sources
1.25 Data Source Details

Data are obtained from Medicare Part A Hospice Fee-For-Service Claims with dates of discharge in Calendar Years 2022 and 2023, corresponding with information used for the Fall 2024 update to the Care Compare site; access was through the CMS Research Data Assistance Center (ResDAC) Chronic Conditions Warehouse (CCW) Virtual Research Data Center (VRDC).