Star Rating Coming for Hospices and Other CAHPS Updates

From the National Association for Home Care & Hospice (NAHC)

The Centers for Medicare and Medicaid Services (CMS) finalized the addition of a CAHPS hospice survey star rating for the hospice quality reporting program in the FY2022 hospice final rule, and the star rating will be publicly reported on Care Compare in August 2022. CMS is calling this star rating the “Family Caregiver Survey Rating Summary star” and hospices with 75 or more completed surveys over the reporting period will have their star rating publicly reported. The rating is the weighted average of the star ratings for each of the eight CAHPS hospice survey quality measures for a hospice.

Hospices will have the opportunity to see their CAHPS Hospice Survey Star Ratings in their official CMS Preview Report during the provider preview period prior to each update of Care Compare. Hospices will first see their Star Ratings in their Preview Reports during the preview periods for the February 2022 and May 2022 updates of Care Compare, which will be a “dry run.” CAHPS Hospice Survey Star Ratings will not be publicly reported in February or May 2022. The reporting period for the dry run is October 1, 2018 – December 31, 2019; July 1, 2020 – March 31, 2021.

The Star Rating for hospices is similar to Star Ratings in other provider types in that it consists of five stars with a range of the lowest score of one star to the highest score of five stars. According to the state and national distribution data posted on the CAHPS hospice survey website for the “dry run” period, the majority of hospices received a rating of 3-stars or 4-stars with 35% and 39% respectively.

CMS will provide more information on the star rating in its Home Health, Hospice & DME Open Door Forum (ODF) on November 10 (see previous NAHC Report coverage here). Until then, some information has been posted to the CMS CAHPS Hospice Survey website including:

• The prepared slide deck for the November 10 ODF that provides an overview of the star rating.
• The star rating technical notes.
• Star rating Frequently Asked Questions (FAQs)
• State and national distributions of the star rating

NAHC is reviewing these documents and will provide a summary over the coming days.

In CAHPS Hospice Survey related updates, CMS recently posted the survey national percentiles for the measures for the Quarter 4 2018 – Quarter 4 2019; Quarter 3 2020 – Quarter 1 2021 public reporting period.  The average measure scores for each state for this same period are available as is the case-mix adjustment methods for CAHPS hospice survey measures document and the most recent CAHPS hospice survey response rate.

New CMS Resources Available: Job Aids 

The Centers for Medicare & Medicaid Services (CMS) is offering companion job aids to assist providers in the assessment and coding of Job Aids – GG0130A. Eating, GG0130B. Oral Hygiene, GG0130C. Toileting Hygiene, GG0130E. Shower/Bathe Self, GG0130F. Upper Body Dressing, GG0130G. Lower Body Dressing, and GG0130H. Putting On/Taking Off Footwear. The job aids provide clinically relevant information to assist providers in understanding specific guidelines and clinical considerations that should be applied to coding GG0130. Self-Care items. These training assets are intended for the following post-acute care (PAC) settings: Home Health Agencies (HHAs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Facilities (LTCHs), and Skilled Nursing Facilities (SNFs). The training materials are available under the Downloads section of the Quality Reporting Program (QRP) Training page for each setting:

• Home Health QRP Training
• Inpatient Rehabilitation Facility QRP Training
• Long-Term Care Hospital QRP Training
• Skilled Nursing Facility QRP Training

If you have questions about accessing the resources or feedback regarding the trainings, please email the PAC Training mailbox ([email protected]). Content-related questions should be submitted to the setting specific help desk:

• [email protected]
• [email protected]
• [email protected]
• [email protected]

Alerts on Aromatherapy Spray, Probiotic Products, and Supplements

Federal agencies have recently issued important alerts or advisories about the safety or deceptive marketing of several complementary health products.

• An aromatherapy spray product has been linked to cases of a serious infection (Centers for Disease Control and Prevention).
• A probiotic product intended for infants has been recalled because of possible bacterial contamination (Food and Drug Administration).
• Dietary supplements promoted as treatments for pain and other aging-related conditions were deceptively marketed (Federal Trade Commission).
• Products promoted as cures for Alzheimer’s disease were marketed with false and unapproved claims (Food and Drug Administration).

WHY HEALTH-CARE WORKERS ARE QUITTING IN DROVES

About one in five health-care workers has left medicine since the pandemic started. This is their story—and the story of those left behind.

The Atlantic / By Ed Yong

The moment that broke Cassie Alexander came nine months into the pandemic. As an intensive-care-unit nurse of 14 years, Alexander had seen plenty of “Hellraiser stuff,” she told me. But when COVID-19 hit her Bay Area hospital, she witnessed “death on a scale I had never seen before.”

Last December, at the height of the winter surge, she cared for a patient who had caught the coronavirus after being pressured into a Thanksgiving dinner. Their lungs were so ruined that only a hand-pumped ventilation bag could supply enough oxygen. Alexander squeezed the bag every two seconds for 40 minutes straight to give the family time to say goodbye. Her hands cramped and blistered as the family screamed and prayed. When one of them said that a miracle might happen, Alexander found herself thinking, I am the miracle. I’m the only person keeping your loved one alive. (Cassie Alexander is a pseudonym that she has used when writing a book about these experiences. I agreed to use that pseudonym here.)

The senselessness of the death, and her guilt over her own resentment, messed her up. Weeks later, when the same family called to ask if the staff had really done everything they could, “it was like being punched in the gut,” she told me. She had given everything—to that patient, and to the stream of others who had died in the same room. She felt like a stranger to herself, a commodity to her hospital, and an outsider to her own relatives, who downplayed the pandemic despite everything she told them. In April, she texted her friends: “Nothing like feeling strongly suicidal at a job where you’re supposed to be keeping people alive.” Shortly after, she was diagnosed with post-traumatic stress disorder, and she left her job.

Since COVID-19 first pummeled the U.S., Americans have been told to flatten the curve lest hospitals be overwhelmed. But hospitals have been overwhelmed. The nation has avoided the most apocalyptic scenarios, such as ventilators running out by the thousands, but it’s still sleepwalked into repeated surges that have overrun the capacity of many hospitals, killed more than 762,000 people, and traumatized countless health-care workers. “It’s like it takes a piece of you every time you walk in,” says Ashley Harlow, a Virginia-based nurse practitioner who left her ICU after watching her grandmother Nellie die there in December. She and others have gotten through the surges on adrenaline and camaraderie, only to realize, once the ICUs are empty, that so too are they.