A Review of Claims-Based Quality Measures Used by the Centers for Medicare and Medicaid Services (CMS) and Medicare Administrative Contractors (MACs) to Monitor the Medicare Hospice Benefit (S754)

Abstract

•Describe measures that CMS and MACs use to monitor hospices participating in the Medicare Hospice Benefit.•Compare characteristics of hospices that are outliers along the five measures to the overall characteristics of all hospices that participate in the Medicare Hospice Benefit. As part of the Medicare Hospice Benefit (MHB), hospices submit claims containing information that allows policy makers to identify outcomes with large variation across hospices. Identifying outliers that have poor outcomes can help policy makers improve the MHB and increase the quality of care being provided. Identify hospices that are outliers in the provision of hospice services along five different quality measures: (1) rate of not providing skilled visits at the end of life (2) average length of stay (ALOS), (3) live discharge rates, (4) general inpatient (GIP) care days, and (5) nursing minutes provided per day. Quality measures are calculated using 100% of Medicare hospice claims from January 1, 2010 through January 31, 2013. For each measure, hospices are grouped into deciles. An overall count of how many times a hospice appears in the eighth decile or higher is made to determine which hospices are outliers. There are 14 hospices that are in the highest three deciles for the first three measures and the lowest three deciles for the last two measures. 226 hospices are in the worst three deciles for at least four measures. The majority of those hospices (70.8%) are located in the south census region, and 80.4% are for-profit providers. The average spending per beneficiary for those hospices is $25,518, compared to $14,977 per beneficiary for all hospices. Using this data, CMS and MACs can identify hospices that are outliers for a given measure. Not all outliers indicate a serious problem, however if a hospice is an outlier for several measures, it may indicate questionable practices and a need for closer inspection by CMS and MAC.