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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
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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.
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
• Strengthen Profitability
• Ensure Compliance
• Improve Quality
Hospice Solution Suite
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
Download & Review Entire QAG V4.0
CAHPS Hospice SurveyHighlights & Updates
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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.
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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.!
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
Roles & Responsibilities:CMS, Hospices & Survey Vendors
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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)
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
Survey Vendor Analysis & Reporting QAG V4.0 Updates (2)
• 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)
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
Survey Vendor Analysis & Reporting QAG V4.0 Updates (3)
• 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
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
HEALTHCAREfirst Hospice CAHPS Updates (2)
• 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
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
HEALTHCAREfirst Hospice CAHPS Updates (3)
• 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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
HEALTHCAREfirst Hospice CAHPS Updates (4)
• 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.
Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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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Copyright © 2017 HEALTHCAREfirst. All rights reserved.
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