It’s official, CMS has put its final stamp of approval on the Hospice Item Set (HIS), and that means lots of progress can be made to prepare. (click here for the full set of measures). Vendors can confidently begin incorporating the HIS data set in their software and hospices can begin to acquaint their staff with the measures and start putting pieces in place to enable performance improvement.

I’d like to share some lessons about implementing process measures (which is what HIS is) from two years ago when CMS introduced them for home health agencies. The good news is that hospices can use these lessons to their advantage and avoid some of the heartache of poor scores. I’m a big fan of learning lessons from someone else’s experience.

When process measures hit home health, the initial scores were dreadful. CMS must have expected that would be the case, because they discarded the first quarter of data. One of the most alarming metrics we observed was Timely Initiation of Care, which indicated there was nothing timely about the initiation of care!  The national benchmark was 87% and began to improve steadily once the problem was highlighted. That metric has now improved by 5.2 points to 92.2%. It’s hard to say whether it was a problem with documentation or actually a process issue, but regardless, there has been dramatic improvement.

Now, I know that CMS changed logic on that measure last year, which makes those quarters not an exact apples-to-apples comparison, but the trend is still valid.  And note that it took agencies, on the average, 60-90 days to come up to speed. If you’re not planning that far out, you’re going to be caught short on your scores.

So what does this mean for hospice?

To avoid the same pitfalls that befell home health agencies, familiarize your staff with the individual process measures now. Incorporate a discussion of one measure at each monthly care conference.  Start early. Do a small, targeted dry run on one measure at a time and see how you do. Are all the necessary processes in place?  Have accountabilities been clearly established?  Are all measure definitions clearly understood by staff? 

By tackling these measures one at a time, you’ll be well-positioned for the July 1st deadline.