Data Paramount in Hospice-Payer, Referral Partner Negotiations

As hospice and palliative care providers move further into value-based care, data is becoming paramount to building payer and referral partner relationships.

In this climate, hospices that can demonstrate their value — and their ability to financially and operationally weather changes in an evolving reimbursement landscape — will have a leg up on competitors. Key data points include performance on the Hospice Item Set, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys and other quality measures. 

Providers will also need to show their potential for reducing costs, primarily through reductions in hospitalizations, emergency department visits and readmissions.


“We all know the great quality of care that really great hospices provide to the patients they serve, but also to the families and communities they work with,” Wes Little, chief analytics officer and general manager for WellSky, told Hospice News. “What’s been missing for a lot of those organizations over the years is hard, cold stats that actually backup the high quality of care that they provide in the metrics that matter most to both the patients and referral sources.”

Other crucial metrics include live discharge rates and hospice visits in the last days of life, according to Little.

WellSky recently introduced a value-based insights for hospice solution that pulls real-time data from claims and electronic health records to give providers visibility into their performance, analyze patterns in their referral activities and benchmark against others in their markets. 


Looking ahead to 2025, some of the key metrics that hospices, payers and referral partners need to watch are changing. The U.S Centers for Medicare & Medicaid Services (CMS) plans to implement its new Hospice Outcomes and Patient Evaluation Tool (HOPE) tool, which will replace the Hospice Item Set. 

When HOPE is implemented, CMS plans to develop additional measures based on the information they will be able to collect through the tool. The agency to date has named two of those potential measures: Timely Reassessment of Pain Impact and Timely Reassessment of Non-Pain Symptom Impact.

“HOPE is going to increase the amount of data that’s captured at the beginning of care, but then also create these touch points along a patient’s experience. If you’re able to have this much more in-depth comprehensive assessment, that’s going to allow you to have a much fuller picture of what the patient is experiencing and where they might be headed,” Little said. “It’s really a sign that Medicare and hospice overall wants to be moving towards a more data-driven measurement of the quality of care that’s provided to individual patients, and therefore at the overall agency level.”

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