As hospices move towards value-based payment models, payers, referral partners and patients and families themselves are paying increasing attention to quality metrics. However, health care providers, including those in the hospice field, would benefit from additional training and workforce development dedicated to quality and safety, according to new research from the National Association for Healthcare Quality (NAHQ).
Researchers surveyed more than 1,600 health care quality professionals from across the continuum. Results indicated that the coronavirus pandemic has exposed flaws and gaps in quality and safety competency that will require additional staff training to correct. Respondents self-assessed the level of work they most often perform across eight health care quality domains based on three proficiency levels: foundational, proficient, and advanced.
“There is no time to waste in health care — our patients need higher quality care and we need to drive costs down,” NAHQ CEO and Executive Director Stephanie Mercado told Hospice News. “We’re hoping this is a wake up call to the health care industry to really start utilizing one of the biggest levers they have to improve quality and safety — and that is their workforce. It’s to identify the competencies that are needed, and that the training on these competencies is an imperative.”
The eight domains included professional engagement, quality leadership and integration, performance and process improvement, population health and care transitions, health data analytics, patient safety, regulatory and accreditation, and quality review and accountability.
Nearly half (48%) of respondents reported their primary job responsibility was in quality management, and 85% reported working in performance and process improvement. About 7% were in regulatory and accreditation; 5% fell into health data analytics and another 5% in patient safety. Two-thirds of respondents indicated they are working in four or more of the competency domains.
Researchers concluded that further development of employees responsible for quality measurement and improvement, safety and compliance would better position providers to improve clinical outcomes and business operations, though this can be challenging for smaller organizations with limited resources.
Hospices will need to leverage strong performance on quality metrics in negotiations with payers within the value-based insurance design (VBID) model demonstration that took effect this year. Medicare advantage plans look closely at star ratings, quality data and Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores when determining which providers to include in their networks.
These data are also becoming a key consideration in the robust hospice mergers and acquisitions market. As the volume of transactions increases and hospice valuations soar, strategic buyers and investors are paying close attention to quality metrics when identifying companies to acquire.
Quality transparency is becoming increasingly important in the Medicare program. The U.S. Centers for Medicare & Medicaid Services (CMS) late last year unveiled its online Care Compare tool that redesigned the agency’s eight quality reporting sites into a single resource, including Hospice Compare. CMS “Compare” websites are intended to aid Medicare beneficiaries in choosing a health care provider based on publicly reported quality data, among other information. Patients can view quality and patient satisfaction scores, cost information as well as data on the providers’ service volume and other metrics.
Concerns about quality in the hospice space have recently come to the forefront as CMS prepares to revamp the hospice survey process pursuant to the Consolidated Appropriations Act of 2021. Congress included these provisions in response to July 2019 reports on hospice quality from the Office of the Inspector General (OIG) at the Department of Health and Human Services (HHS).
CMS recently included these provisions in the proposed 2022 home health payment rule. The rule would create a Special Focus Program (SFP) with the power to impose enforcement remedies against hospices with poor performance on regulatory or accreditation surveys. The agency also has plans to implement a hospice program complaint hotline through which the public can report issues to CMS and to make deficiencies cited in accreditation survey reports available to the public.
A focus on developing standardized quality improvement can enhance patient care, communication and collaboration among staff, and also impact a hospice’s bottom line, according to Mercado.
“When you speak the same language and use the same quality tools, you reduce friction in collaboration and care coordination across the continuum of care,” Mercado said. “With quality review and accountability, that is the dimension that really focuses a lot on reimbursement in payment models. You’re making sure that they understand how the work that they are doing and the care they’re providing actually impacts their performance measures and their payments as well.”
In addition to financial and regulatory concerns, hospices naturally want to improve the care experience for patients and families, but NAHQ researchers suggested in their report that many health care providers lack a robust quality and compliance infrastructure.
Working to build an organizational safety culture oriented around key competencies can give hospices a competitive edge, according to Lenard Parisi, former president of NAHQ and senior director of nursing, quality and magnet recognition at Mount Sinai Hospital in New York, but this requires allocating resources to perform deeper dives into quality performance.
Engaging professionals who have knowledge and experience in quality improvement and compliance represents a “win-win,” Parisi told Hospice News.
“Having designated quality professionals who have these competencies and the ability to execute and work with teams to drive performance improvement initiatives is essential for hospices,” said Parisi. “When you put the clinical competencies and the nonclinical competencies together, you have a key to open the door to get higher quality outcomes. If we arm clinicians and other staff with these competencies for quality and safety, they really become a master of the craft.”
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