How Hospice Quality Reporting Can Impact Recruitment, Retention

Quality data are becoming another arrow in the quiver for hospices seeking to improve retention and recruitment.

A hospice’s publicly reported quality data can paint a picture of how an organization stands up against competitors for future and current staff.

Quality scores also can serve as a baseline for educating staff on how their roles tie into compliance and patient experiences, according to Mary Jane Ruppert, assistant vice president of clinical services, Heartland Home Care & Hospice.


“Some of the challenges we face as an organization are with the quality measures, as well as certainly turnover of staff, but also staff coming to hospice that don’t have a lot of experience in hospice and may not have experience in knowing what a reported quality measure is, what it means, or how they impact it,” Ruppert said during the National Hospice and Palliative Care Organization (NHPCO) Interdisciplinary Conference.

Highlighting measures in the Hospice Quality Reporting Program (HQRP), for example, can give new and inexperienced staff a better grasp on the types of experiences they’ll be facilitating for patients and families, Ruppert explained.

The hospice provider began using its consumer quality guide in its training, onboarding and recruitment efforts to help staff understand the nuances of working in the sector, she said. Although the guide is designed for consumers, it has been particularly helpful for employees or candidates who are inexperienced in hospice, Ruppert stated.


“It affords them the opportunity as well to put themselves in the families’ shoes, and help them think about what is this measure looking at, and what does it all mean?” Ruppert said. “We found that really helpful for our new staff, and then we can kind of move them into a more in-depth conversation and education about the specific quality measures.”

With potential new measures in HQRP under consideration, leaders may need a sharper gaze on how they measure up on certain publicly available data.

The U.S. Centers for Medicaid & Medicare Services (CMS) included updates to some of these initiatives in its 2024 proposed hospice payment rule.

This includes the possibility of new health equity-related measures. CMS has a technical expert panel (TEP) to examine the potential addition and included requests for information (RFI) designed to gather insight on how hospices are approaching health equity.

In addition, the Hospice Outcomes & Patient Evaluation (HOPE) tool, currently in a testing phase, is anticipated to replace the Hospice Item Set (HIS).

CMS currently uses claims data gathered from a set of HIS measures that represent different aspects of hospice care processes between patient admission and discharge. These measures are included as part of the HQRP. In contrast, the HOPE tool is designed to assess patients in real-time based on their interactions versus a retrospective review of quality requirements, according to CMS.

These changes come at a time when hospices are being challenged operationally to ensure staff are well-versed in compliance, according to Dianne Hansen, CEO at Partners In Home Care, Inc.

“Most agencies probably at some point in working with their staff have struggled with the definitions of many of these items,” Hansen said during the conference.

Ensuring that staff understand both the parameters around quality requirements and the impacts these measures have on care delivery is a significant part of onboarding and ongoing training, according to Hansen. This makes compliance education a key in retention, she indicated.

“For each of the quality teams that work in your organization, you have to start with making sure that everyone has a solid understanding of what’s being measured here to be the foundation of your quality program,” Hansen said. “Because if you just look at the title of these measures, sometimes you wouldn’t really necessarily be impacting the core of what this item is measuring.”

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