Hospice Stakeholders Develop Two Palliative Care Quality Measures

The American Academy of Hospice and Palliative Medicine (AAHPM) has unveiled two new patient-reported quality measures for community-based palliative care. These were born as part of the first funding initiatives to develop measures for the U.S. Centers for Medicare & Medicaid Services (CMS) Quality Payment Program, including the Merit-Based Incentive Payment System (MIPS) and alternative payment models.

CMS in 2018 awarded $5.5 million to support a three-year palliative care project aimed at developing, improving and expanding measures to improve patient outcomes and drive high-quality care. A public-private coalition of seven organizations collaborated on the project. With the recent completion of the Palliative Care Measures Project this month, these measures became available to hospice, palliative care and other providers to implement in their practice.

At the project’s launch, then CMS Administrator Seema Verma emphasized the importance of collaborating with clinicians, patients and other key stakeholders to identify quality measures that will meaningfully impact patient care.

“Through our Meaningful Measures Initiative, CMS is committed to advancing measures that minimize burden on clinicians, improve outcomes for patients and drive high-quality care,” said Verma in 2018. “We need the expertise and firsthand experience of those on the front lines to develop measures that achieve these goals.”

The two new measures fall under the category of “patient-reported outcome performance measures” (PRO-PMs) that specifically assess quality of care using two main indicators:

1) How much patients felt heard and understood
2) If patients got the help they wanted for their pain.

“We are most proud that the new measures incorporated patient, caregiver and family input, along with clinical and other stakeholder feedback, during the entire measure development process,” said Amy Melnick, executive director of National Coalition for Hospice and Palliative Care (NCHPC).

The project involved a collaboration that included NCHPC, AAHPM and the RAND Corporation, a research organization that focuses on public policy. Other organizations included an array of clinical professional organizations, patient advocacy groups, educational and independent research institutions and health systems.

The measures address what the AAHPM called the “most significant gaps in care today” — patient-centered, effective symptom management and communication.

Symptom management and communication with patients and their families are linked to providers’ financial sustainability. A lack of timely communication and ineffective pain and symptom management can significantly impact a provider’s publicly reported quality and family satisfaction scores. Quality data measures are key considerations for potential payers, referral partners and patients alike.

“Elevating the voices of patients and caregivers has been prioritized in every aspect of this initiative.” said Rebecca Kirch, executive vice president of policy and programs at National Patient Advocate Foundation (NPAF). “NPAF applauds the inclusive and innovative approach of this remarkable partnership.”

A review of the measures from Feb. 1 to March 2 this year found that 83% of more than 200 respondents including health care professionals, patients and advocates were “very or somewhat likely” to use the measure of “feeling heard and understood,” while 72% indicated the same regarding the “receiving desired help for pain” measure.

While CMS does not require reporting on these measures, they can help providers gauge whether their services are meeting patient and family needs and help identify resources they may be lacking.

A technical expert clinical user patient panel developed, tested and implemented the measures. Both measures have been submitted for consideration to obtain endorsement from the National Quality Forum (NQF) during the fall 2021 review cycle.

Authorized under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the newly introduced palliative care measures will help to shape Medicare’s Quality Payment Program. The program features two participation pathways for providers: the Merit-based Incentive Payment System (MIPS) measures performance in four categories to determine an adjustment to Medicare payment; and Advanced Alternative Payment Models (Advanced APMs), in which providers earn an incentive payment through sufficient participation in risk-based payment models.

The measures establish “more appropriate measures for clinical specialties underrepresented in the current measure set with the goal of improving patient care, and focus on outcome measures, including patient-reported and functional-status measures, to better reflect what matters most to patients,” according to CMS.