In Extended Care & Home Health

There are times when less is more, like when we de-clutter our homes in the spring. With public reporting, the opposite is true. As hospice reporting comes into line with home health—heading toward a pay-for-quality reporting program—the best advice for organizations is to go beyond what’s now required. That applies to both timely performance of tasks and documentation.

For example, hospice organizations are wise to take seriously the requirement to complete a clinical assessment for pain within 24 hours of a positive pain screening. First, ensure your processes match the requirement from the Centers for Medicare & Medicaid Services (CMS), then go beyond by examining whether or not all your clinicians are following that process. To help ensure compliance, perhaps your internal deadline should be a same-day assessment, rather than waiting to the next day.

If you’ve been in healthcare for any amount of time, you know that more documentation is always better than less, whether you’re dealing with federal payers or trying to prepare an accurate assessment of a patient’s health status. Doing the bare minimum, however, can put your organization in danger of not meeting CMS standards.

Consider the pain example again: Every instance should be assessed for location, severity, duration, frequency, what relieves or worsens the pain, and the effect on function or quality of life. Simply checking a box saying you did a pain assessment without further documentation doesn’t create a full picture for other clinicians involved with the patient, and isn’t what CMS is looking for.

Meeting the Comprehensive Measure

Some hospice organizations are getting tripped up on the comprehensive measure, a compilation of each of the seven key measures:
1. Treatment preferences assessed and documented
2. Beliefs/values assessed and documented
3. Bowel regimen recommended if patient is taking an opioid
4. Pain screening performed and documented
5. Pain assessment performed and documented
6. Dyspnea screening performed and documented
7. Dyspnea treatment recommended

The comprehensive measure is not yet a part of Hospice Compare, but there’s a good chance it soon will be. And because a low score in any of the seven areas pulls your agency’s comprehensive score down, it can be difficult to manage.

This is where going above and beyond fits in, in the form of a robust, well thought-out Quality Assurance and Performance Improvement (QAPI) process to monitor your processes and results, discover weak areas, and address those areas quickly and efficiently. There should never be a question about how to address these areas, who’s in charge of implementing the changes, or whether the change generated the desired improvement.

Barbara Fadeyi is a Business Systems Analyst, and Richard Gardner is a Senior Product Manager for Business Intelligence and User Interface, both at Change Healthcare.

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