End-of-life care is often complex and nuanced. Along with a growing need for hospice care in the United States, it is critical that patients and their families receive high-quality hospice care during this vulnerable and personal journey.
But what defines high-quality hospice care, and how can providers know they are referring their patients to a hospice agency that excels at delivering it? There are a few guiding principles that can help providers choose a sound referral partnership.
What is Quality Hospice Care?
Hospice care is not only end-of-life care — it is quality of life care. For each person enrolled in hospice care, quality of life will be defined differently, based on their unique needs and goals. Quality hospice care addresses these goals in a holistic, comprehensive manner.
Some elements of a high-quality hospice program include:
- Emphasis on goals-of-care discussions with patients and their families
- Measures to address caregiver burnout including education and respite care
- Spiritual and emotional care that is tailored to individual circumstances
Medicare-certified hospice providers must adhere to Medicare Conditions of Participation (CoPs) requiring an interdisciplinary approach to the following elements of care planning: 1
- Clinical strategies for effective pain relief and symptom control
- A comprehensive outline detailing how often and to what extent each care team member will visit
- Medications and therapeutic procedures tailored to address the patient’s specific health requirements
- Clearly defined goals with regular progress evaluations
- Essential equipment and medical supplies required to support the patient’s care
- Records from the care team reflecting the patient’s or their representative’s comprehension, participation, and consent regarding the care plan, aligned with hospice policy
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Hospice Quality Benchmarks
When choosing a hospice referral partner, there are a few specific benchmarks to look for that can help highlight the quality of care provided.
1. Hospice Item Set (HIS)
The Hospice Item Set (HIS) is a uniform reporting instrument established by Medicare to evaluate the standard of care delivered by hospice providers. It includes a series of indicators designed to document key patient data, approaches to symptom control, and the overall care experience. Hospice organizations regularly submit this information to Medicare for review.
2. Hospice Visits Last Days of Life (HVLDL)
This metric evaluates the frequency of hospice staff interactions with patients during their final days. It is derived from Medicare hospice billing data and reflects the percentage of patients who were visited in person by either a registered nurse or a medical social worker on a minimum of two out of the last three days of life. 2
3. Hospice Care Index (HCI)
The hospice care index is a comprehensive measure of ten claims-based indicators of quality hospice care: 3
- Continuous Home Care (CHC) or General Inpatient (GIP) provided
- Gaps in skilled nursing visits
- Early live discharges
- Late live discharges
- Burdensome transitions (Type 1) – Live discharges from hospice followed by hospitalization and subsequent hospice readmission
- Burdensome transitions (Type 2) – Live discharges from hospice followed by hospitalization with the patient dying in the hospital
- Per-beneficiary Medicare spending
- Skilled nursing care minutes per routine home care (RHC) day
- Skilled nursing minutes on weekends
- Visits near death
4. Consumer Assessment of Healthcare Providers and Services (CAHPS) Survey
The CAHPS Hospice Survey is a nationwide assessment targeting relatives or close companions of individuals who passed away while receiving hospice services. 4 Administered on a monthly basis, the survey features 47 items that explore areas relevant to both hospice patients and their caregivers. The findings are publicly available through the Care Compare section of the Medicare.gov website.
Amedisys and Quality Hospice Care
At Amedisys, we pride ourselves on industry-leading quality of care. It’s one reason nearly 3,000 hospitals and 110,000 physicians nationwide partner with us to provide care in the home. As a Medicare-certified hospice agency, we strive to offer holistic care that enhances the quality of life and dignity of those we serve.
Our quality measures reflect our success:
1. Amedisys Outperforms National CMS Averages on 7/7 HIS Measures
In all seven measures, Amedisys scores at 99% or above.
2. Amedisys Significantly Exceeds the National HVLDL Average
At Amedisys, we’ve developed a protocol called Code Green, which activates an increased rotation of visits from clinicians so no patient transitions alone. The national average from April of 2022-March of 2024 for HVLDL stands at 53.8%; during the same period, 80.2% of Amedisys hospice participants received a visit on a minimum 2 out of 3 of the last days of life.
3. Amedisys Outperforms the National Hospice Care Index Average
The national HCI average is 8.8; Amedisys’ average HCI is 9.7.
4. Amedisys Performs Well on the Hospice CAHPS Survey
Amedisys’ satisfaction rates on the Hospice CAHPS survey perform well against the national CMS averages.
These results demonstrate the commitment to high-quality hospice care that we make to our patients, families and referral sources.
Ready to learn more about referring eligible patients to Amedisys hospice? Fill out the contact form below to connect with our specialists.
Kellie Leonette, MSN, RN, is Hospice Quality Management Director for Amedisys. She has 41 years of experience in healthcare, including 20 years in hospice care, and believes strongly in the team approach to healthcare that is demonstrated with hospice.
