Hospice Quality Reporting Program: Measures and Compliance for Quality Professionals
Overview of Hospice Quality Reporting
The Hospice Quality Reporting Program (HQRP) was established by CMS to improve transparency and accountability in hospice care. Medicare-certified hospice providers must submit quality data to avoid a two percentage point reduction in their annual payment update. The program reflects the growing emphasis on measuring quality across all care settings, including end-of-life care. Quality professionals should understand the HQRP because it illustrates how quality measurement principles apply to a setting where cure is no longer the goal and comfort, dignity, and symptom management are the primary priorities.
HQRP Quality Measures
The HQRP measure set includes process measures, outcome measures, and patient experience measures. Process measures address areas such as pain screening, pain assessment, dyspnea screening, and treatment preferences documentation. Claims-based measures track hospice visits in the last days of life, ensuring that patients receive adequate support during their final days. Outcome measures focus on symptom management effectiveness. The Hospice Item Set (HIS) is the assessment instrument used to collect data on process measures at admission and discharge from hospice services.
The CAHPS Hospice Survey
The CAHPS Hospice Survey captures the perspectives of bereaved family members and caregivers about the care their loved ones received. The survey covers domains including communication with the hospice team, timeliness of care, symptom management, emotional and spiritual support, and training for family caregivers. Survey results are publicly reported on the CMS Care Compare website. Quality professionals use survey data to identify areas where the hospice team can improve communication, responsiveness, and family support.
Data Collection and Compliance
Hospice providers collect HIS data at admission and discharge for all patients. Data must be submitted to CMS through the Quality Improvement and Evaluation System (QIES) Assessment Submission and Processing (ASAP) system. Compliance with submission requirements is tracked, and providers that fail to meet reporting thresholds face payment reductions. Quality professionals oversee data collection processes, train clinical staff on accurate HIS completion, and monitor submission compliance to ensure the organization meets all reporting requirements.
Quality Improvement in Hospice
Quality improvement in hospice care focuses on enhancing symptom management, improving communication with patients and families, ensuring timely access to services, and supporting staff competency and wellness. Performance improvement projects may address areas such as reducing unmanaged pain, improving the timeliness of initial assessments, strengthening bereavement support programs, and enhancing coordination with referring providers. Quality professionals facilitate these projects using standard quality improvement methodologies such as Plan-Do-Study-Act (PDSA) cycles, applied with sensitivity to the unique goals and values of end-of-life care.