Hospice CAHPS V4 - Amazon S3 · • On‐demand video will be made available following the webinar. 2. 11/14/2017 ... • Web‐based Agency Management Software for home health &

11/14/2017

QAG 4.0 & Hospice CAHPS Update (c)HEALTHCAREfirst 11/2017 1

Copyright © 2017 HEALTHCAREfirst. All rights reserved.

Hospice CAHPSQuality Assurance Guidelines V4.0 Highlights & UpdatesPresented by:Liz Silva, HEALTHCAREfirst Director of Home Health & Hospice


Before We Get Started

• Audio is through computer speakers or select “Phone” on Audio Pane to call in. All attendees are muted.

• You can ask questions via the GoToWebinar Question Pane throughout the presentation.

• Handout can be found on the “Handout” pane in the GotoWebinarControl Panel.

• On‐demand video will be made available following the webinar.

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About HEALTHCAREfirst

• Industry leader in Web‐based EHR software, coding & billing services, CAHPS survey administration, and advanced analytics for home health and hospice:

– Founded in 1992

– Headquartered in Springfield, MO with additional office in Louisville, KY

– One of the fastest growing providers of our kind

– More than 4,000 home health and hospice agencies nationwide

• We enable our customers to:– Make timely and accurate decisions for excellent patient care

– Adapt quickly to changing requirements and needs

– Automate agency functions quickly and with high value.


SOFTWARE• Web‐based Agency Management Software for home health & hospice agencies

• DDE Connectivity

• All Payer Eligibility Verification

• Physician Portal

• OASIS Scrubber

SERVICES• Coding

• OASIS Review

• Billing

• CMS Submission of Hospice Item Set Data

ADVANCED ANALYTICS• Executive, Clinical and Financial KPIs

• Market insights to grow referrals

• Robust QAPI management & benchmarking

• Hospice CAHPS & Home Health CAHPS

EHR Software and Beyond

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• Strengthen Profitability

• Ensure Compliance

• Improve Quality

Hospice Solution Suite


Agenda

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• CAHPS Hospice Survey Highlights & Updates*

• Roles & Responsibilities– CMS

– Hospice agencies

– Survey vendors

• Adjustments, Analysis & Reporting Results– CMS Updates

– HEALTHCAREfirst Hospice CAHPS Updates

• Q&A* Highlights from the QAG V4.0 and the CAHPS Hospice Survey Update Training (Sep 2017).

Be sure to download and review all details in outlined in the QAG V4.0.

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Download & Review Entire QAG V4.0

CAHPS Hospice SurveyHighlights & Updates


CAHPS Hospice Survey Website

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• Be sure to bookmark and/or visit the website often!http://www.hospicecahpssurvey.org

– What’s New

– QAG V4.0

– Information for Hospices (FAQs, Podcasts)

– Survey materials with translations for each available language

– Authorization and request forms

– Technical information

– More…

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Survey Instrument

• 47 questions broken down into 3 sections:– Core questions (Q1‐40)

– Your Family Member (Q41‐43)

– About You (Q44‐47)

• Up to 15 supplemental questions

• Survey languages: English*, Spanish*, Chinese, Russian, Portuguese, Vietnamese, Polish and Korean.

• Cover letter to include wording stating participation is voluntary and will not affect any health care or benefits.

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* Survey vendors are required to administer in English & Spanish. Other languages are optional.


Survey Eligible Decedents/Caregivers

• Decedents of all payer types are eligible for sampling

• Include:– Decedents at least 18 years old at the time of death

– Decedents with a LOS of at least 48 hours

– Decedents with a caregiver of record

– Caregiver is someone other than a non‐familial legal guardian

– Caregiver lives within US or US Territory

• Exclude:– Patients who were discharged alive

– ‘No Publicity’ decedents/caregivers

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Clarification: ‘No Publicity’

• ‘No Publicity’ decedents/caregivers are those who initiate or voluntarily request at any time during their hospice stay that the hospice:1. Not reveal the patient’s identity

and/or

2. Not survey him/her

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‘No Publicity’ is NOT intended as an ‘opt out’ option for the hospice to choose which records to exclude from sampling.!


Survey Communication Guidelines

• CAN– Let ALL caregivers know they may receive a survey– Encourage caregivers to complete the survey

• CANNOT– Attempt to influence caregivers to answer a certain way– Imply someone will be rewarded or benefit from positive feedback– Ask caregiver to explain why they answered a certain way– Indicate your hospice’s goal– Offer incentives– Show/provide survey or cover letter to decedent/caregiver– Ask any CAHPS Hospice Survey (or similar) questions (and responses)– Mail/distribute any pre‐notification letters/postcards after death

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Use of Other Hospice Surveys

• Should not administer any formal, CAHPS Hospice Survey‐like, patient experience/satisfaction survey prior to the official CAHPS Hospice Survey

• Must avoid activities or encounters intended to influence how caregivers –or which caregivers – respond to the survey

• Questions must not resemble CAHPS Hospice Survey questions or responses:

– On a scale of 0‐10, how would you rate your care?

– Is there a way we could always…?

– Did the hospice team explain things in a way that you could understand?

– Overall, how would you rate the care you received from the hospice?

• May not reference CMS or CAHPS Hospice Survey

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Survey Administration & Data Submission Remainder of CY 2017 (FY 2019 APU)

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Sample Month& Quarter

Initial Mailing (During 1st week)

End Data Collection (42 days)

Vendor SubmitsData to CMS

Q3 2017

Jul 2017 Oct 2017 Mid Nov 2017

Feb 14, 2018Aug 2017 Nov 2017 Mid Dec 2017

Sep 2017 Dec 2017 Mid Jan 2018

Q4 2017

Oct 2017 Jan 2018 Mid Feb 2018

May 9, 2018Nov 2017 Feb 2018 Mid Mar 2018

Dec 2017 Mar 2018 Mid Apr 2018

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Survey Administration & Data Submission CY 2018 (FY 2020 APU)

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Sample Month& Quarter

Initial Mailing (During 1st week)

End Data Collection (42 days)

Vendor SubmitsData to CMS

Q1 2018

Jan 2018 Apr 2018 Mid May 2018

Aug 8, 2018Feb 2018 May 2018 Mid Jun 2018

Mar 2018 Jun 2018 Mid Jul 2018

Q2 2018

Apr 2018 Jul 2018 Mid Aug 2018

Nov 14, 2018May 2018 Aug 2018 Mid Sep 2018

Jun 2018 Sep 2018 Mid Oct 2018

Q3 2018

Jul 2018 Oct 2018 Mid Nov 2018

Feb 13, 2019Aug 2018 Nov 2018 Mid Dec 2018

Sep 2018 Dec 2018 Mid Jan 2019

Q4 2018

Oct 2018 Jan 2019 Mid Feb 2019

May 8, 2019Nov 2018 Feb 2019 Mid Mar 2019

Dec 2018 Mar 2019 Mid Apr 2019


Switching Survey Vendors

• May only switch vendors at the beginning of a CY quarter

• Hospices interested in switching vendors must:– Contact the CAHPS Hospice Survey Project Team right away

– Submit the CAHPS Hospice Vendor Authorization Form at least 90 days prior to the data submission deadline:

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Sample Month to Begin with HEALTHCAREfirst

CMS Submission Deadline

Vendor Change Form Submission Deadline

Q4 2017 (Oct – Dec) Feb 14, 2018 Nov 16, 2017

Q1 2018 (Jan – Mar) May 9, 2018 Feb 8, 2018

Q2 2018 (Apr – Jun) Aug 8, 2018 May 10, 2018

Q3 2018 (Jul – Sep) Nov 14, 2018 Aug 16, 2018

Q4 2018 (Oct – Dec) Feb 13, 2019 Nov 15, 2018

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Roles & Responsibilities:CMS, Hospices & Survey Vendors


Roles & Responsibilities: CMS

• Provide calculations and adjustments to survey results– Mode

– Case mix

• Create preview reports prior to public reporting

• Provide CAHPS Hospice Survey results for public reporting on Hospice Compare (www.medicare.gov/hospicecompare)

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Roles & Responsibilities: Hospices

• Contract with approved Hospice CAHPS vendor• Authorize survey vendor and complete CAHPS Hospice Survey Data

Warehouse Access Form at least 90 days prior to data submission deadline

• Provide complete and accurate monthly data for each CCN in a timely manner prior to sampling:– Decedent/caregiver list– Monthly counts/volumes

• Review Data Warehouse Data Submission Reports every quarter.• Review survey data in Preview Reports before publicly reported

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Accessing Data Warehouse

• Updated instructions in QAG V4.0 – Data Administrator will receive an email with a link to the data

warehouse (https://kiteworks.rand.org)

– Click on the link to be routed to login page to enter user ID and password

– Select organization name on All Files tab

– Select Actions in upper right hand corner followed by Upload to view and download reports.

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Review Data Submission Reports (1)

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• All hospices should review the 4 Data Submission Reports after they are uploaded to their Data Warehouse folder:

1. Data Submission Detail Report (Part 1) – Indicates if data submitted by vendor was accepted and processed

2. Data Submission Detail Report (Part 2) – Indicates if data passed quality data checks. If Data Value Checks Status shows as:

• Rejected = Errors exist; Vendor must submit new file

• Accepted = No errors; no further action required


Review Data Submission Reports (2)

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3. Survey Status Summary Report – Lists the following details separately by month of death & overall:

• Whether record was accepted

• Sample size

• # of administrative records

• # of valid survey status codes

• # of completed surveys

4. Review and Correction Report – Lists the # of valid and invalid responses to each variable in the file

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Participation Exemption

• Exemption for SIZE– Can apply for exemption for a CCN if there were < 50 survey‐eligible

decedent/caregivers in prior CY

– Must submit the Participation Exemption for Size Form

– Deadline to submit form for CY 2018 exemption: December 31, 2018

• Exemption for NEWNESS– Exempt only for the CY that the CCN is assigned

CCN received any time in 2017 would begin with Jan 2018 decedents

– No form necessary – CMS will identify exempt hospices

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Participation Options for Hospices Eligible for Exemption

• Option 1: Choose NOT to participate*– MUST submit Participation Exemption for Size form

• Option 2: Choose to officially participate*– Must comply with protocols listed in QAG including all data collection, surveying

and reporting requirements– Data must be submitted to CMS; available for public reporting– Must authorize HEALTHCAREfirst

• Option 3: Choose to unofficially participate**– MUST submit Participation Exemption for Size form

Unofficial participation does not fulfill data collection and reporting requirements– Survey materials must not include any references to CMS/Hospice CAHPS– Data collection cannot be submitted to CMS

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* Option is for the calendar year. ** Not offered by HEALTHCAREfirst.

Safest ApproachBegin participating in January (Q1)

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Monthly Decedent/Caregiver List

• Complete and accurate decedent/caregiver list provided before sampling

• One record per decedent/caregiver

• Must include ALL deaths (Only exception = ‘No Publicity’)– Not permissible to omit decedents/caregiver from the list

• Must include caregiver information*– Not permissible to withhold or not include caregiver information

– New field added by CMS: Caregiver LanguageNot new for HEALTHCAREfirst clients; No update needed.

• Must NOT include live discharges

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Monthly Counts/Volumes

• Separate monthly counts/volumes for each CCN:– Deaths

– ‘No Publicity’ cases

– Live discharges

– # of Administrative Offices for the CCN

• Must be submitted in a file each month; Written documentation if there are no survey‐eligible records

• Must be consistent with # of decedent/caregiver records:

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(# Deaths) – (# ‘No Publicity’) =# records in monthlydecedent/caregiver list

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Roles & Responsibilities: Survey Vendors

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• Follow survey administration protocols established in the QAG including (but not limited to):– Review decedent/caregiver lists for discrepancies/issues

•

• Review ‘No Publicity’ count for reasonableness

– Determine survey eligibility

– Create sample frame

– Administer survey and collect responses

– Quarterly data submission to Data Warehouse

– Submit Discrepancy Notification Reports to CMS


Discrepancy Notification Reports

• Required for any discrepancy or variation in following standard survey administration protocols

• Vendors must submit to CMS immediately when identified. Examples :– Survey administered too early or too late

– Eligible decedent/caregivers excluded or ineligible decedent/caregivers included in survey administration

– Surveys administered to patients discharged alive

– Inaccurate monthly counts or inability to obtain missing or correct data

• Reports are reviewed by CAHPS Hospice Survey Project Team– Outcome of review may not be provided until after all data for the affected period

have been reported.

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Copyright © 2017 HEALTHCAREfirst. All rights reserved. 29

Adjustments, Analysis & Reporting Results


8 Hospice CAHPS‐based Quality Measures

• 2 Global Measures– Rating of Patient Care (Q39)

– Willingness to Recommend (Q40)

• 6 Composite Measures– Hospice Team Communication (Q6, 8, 9, 10, 14, 35)

– Getting Timely Care (Q5, 7)

– Treating Family Member with Respect (Q11, 12)

– Getting Emotional & Religious Support (Q36, 37, 38)

– Getting Help with Symptoms (Q16, 22, 25, 27)

– Getting Hospice Care Training (Q18, 19, 20, 23, 29)

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Public Reporting – Hospice Compare(www.medicare.gov/hospicecompare)

• Winter 2018: Anticipate Hospice CAHPS measures will join HIS‐based quality measures on Hospice Compare

• CCN‐level results

• Rolling 8‐quarters of data

• Provider Preview Reports– Made available on CASPER 2 months prior to public reporting

– Hospices will have 1 month to review

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Public Reporting – Hospice Compare(www.medicare.gov/hospicecompare)

• Adjustments made for Case Mix and Mode prior to publicly reporting results– “Level the playing field”

– Ensure differences in scores reflect differences in quality only

• Adjusted results posted on Hospice Compare official results– Will likely be different from unadjusted results reported by survey

vendors

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Case Mix Adjustment

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• Certain decedent/caregiver characteristics affect how someone might respond to the survey:– Decedent age– Caregiver Age– Caregiver education level– Survey language– Decedent/caregiver

relationship

• Adjustments updated quarterly and published on CAHPS Hospice Survey website

– Payer– Primary Diagnosis– LOS– Language spoken at home– Response percentile

(calculated by ranking lag time)


Mode Adjustment

• Caregiver responses are affected by mode of administration

• 3 survey administration modes:– Mail Only

– Telephone Only

– Mixed Mode (mail with telephone follow‐up)

• Adjustments are based on results of the 2015 CAHPS Hospice Survey mode experiment.

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Why Adjust Results?

• Decedent/caregiver characteristics or survey administration mode differences are large enough to bias comparisons

• Examples from 2015 Mode Experiment:– Parent or spouse/partner more likely to respond than child/step‐child

– Lowest response rate for Telephone Only

• Mixed Mode: 53%

• Mail Only: 43%

• Telephone Only: 38%

– More negative response tendencies for Telephone Only

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Survey Vendor Analysis & Reporting QAG V4.0 Updates (1)

• Removed restrictions for reporting results with fewer than 11 responses

• Survey vendor results are “unofficial” results – only CMS published results are official.– Can use vendor results to drive quality improvement

– If hospices choose to use survey vendor scores, they must indicate that they are not official CMS scores.

– Survey vendor reports must include the following statement:

This report has been produced by <Survey Vendor Name> and does not represent official CAHPS Hospice Survey results.

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• Any responses that would identify a particular decedent/caregiver case should not be shared with direct care staff. – These results should be limited to management and/or quality

improvement personnel

– Applies to all responses, including open ended comments

– If follow‐up with direct care staff is necessary, hospice should not identify the caregiver who provided the response

– OK to share compliments with staff, however decedent/caregiver should not be identified

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Source: CAHPS Hospice Survey Update Training (Sep 2017)Update Training Questions & Responses (Nov 2017)



• Removed references to the Consent to Share Responses supplemental question

• REMINDER: Hospice cannot use comments – even if they are anonymous – as testimonials or for marketing purposes.

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Copyright © 2017 HEALTHCAREfirst. All rights reserved. 39

HEALTHCAREfirst Hospice CAHPS Updates


HEALTHCAREfirst Hospice CAHPS Updates (1)

1. Updates available November 17, 2017:– Removal of reporting restrictions when fewer than 11 responses

– New look for reports, reporting portal and resource library materials• Report guides

• Resource guides

• User guides

2. Reporting changes for results from surveys administered beginning January 2018 (October 2017 sample month):– Removal of Consent to Share Responses question and restrictions

previously associated with caregiver’s response

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• CMS required statement that vendor results are unofficial included on all reports

• Removal of restrictions when reporting fewer than 11 responses– Drilldown Reports no longer restricted – All reporting hierarchy details displayed

• Inclusion of previously restricted questions about Patient‐caregiver relationship; Location(s) of care; Patient/caregiver demographics– Q1: Patient/caregiver relationship– Q2: Location of hospice care– Q32‐34: Hospice care in nursing home

• New Demographic Report providing patient caregiver characteristics

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– Q41‐47: Patient/caregiver demographics– D50‐52: Inpatient hospice care received



• Beginning with surveys administered January 2018 (Oct 2017sample month), HEALTHCAREfirst Hospice CAHPS surveys will not include the Consent to Share Responses question

• Results for surveys administered through Dec 2017 (Sep 2017 sample month) will be restricted based on caregiver’s response to Consent to Share Responses question:– ‘Yes’ response: HEALTHCAREfirst can link results and comments to

decedent/caregiver record

– ‘No’ or blank/no response: HEALTHCAREfirst cannot link results, Not available will appear for patient/caregiver identifiers

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• Results displaying patient‐ or survey‐level details will include all available patient/caregiver identifiers* for surveys administered in January 2018 (Oct 2017 sample month) and beyond. – Individual Survey Report

– Comment Notifications & Reports

– Survey & Comment Alert! Search

– Drilldown Reports

– Raw Data Extracts

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* If a caregiver does not want to be identified, Not available will appear in patient/ caregiver identifier fields.


Important Links & Resources

• CAHPS Hospice Survey websitewww.hospicecahpssurvey.org

• CAHPS Hospice Survey Project [email protected]‐472‐4621

• Hospice Comparewww.medicare.gov/hospicecompare

• Hospice Quality Reporting Programhttps://www.cms.gov/Medicare/Quality‐Initiatives‐Patient‐Assessment‐Instruments/Hospice‐Quality‐Reporting/Hospice‐Quality‐Public‐Reporting.html

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2017 HEALTHCAREfirst Enhancements

• Exciting HEALTHCAREfirst Partnerships– Qualis Management Interface– PDC (Palliative Drug Care) Interface– ABILITY Interface (firstREV)– Medline Medical Supply Interface– Optum PBM Interface

• Enhancements in 2017– HEALTHCAREfirst’s EHR Software, innovative, fresh new look– NOE Link™ – CAREpliance™ Care Planning Technology in firstHOSPICE (Coming Soon)

• firstHOSPICE Solution Spotlight Webinar– November 16th and 30th

– www.healthcarefirst.com/webinars

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Thank You

• On‐demand video will be made available following the webinar.

• We want to hear from you! Please fill out the survey.

Contact HEALTHCAREfirst

800.841.6095

www.healthcarefirst.com

[email protected]

Documents

Hospice CAHPS V4 - Amazon S3 · • On‐demand video will be made available following the webinar. 2. 11/14/2017 ... • Web‐based Agency Management Software for home health &