A provider’s performance on the Hospice Care Index (HCI) can give it an edge when it comes to payer negotiations in value-based programs.
The HCI — which the U.S. Centers for Medicare & Medicaid Services (CMS) introduced in its 2022 final rule for hospice payments — assigns the provider a score based on 10 claims-based quality indicators.
“These measures are going to give you a place at the value-based care table,” Robin Stawasz, program development executive at health care technology firm Acclivity Health, told Hospice News. “As far as contracting opportunities, if you’re not at the table — then you’re likely on the menu. Being able to get ahead and control your own destiny for hospices is tremendously important.”
As much as 10% of hospices nationwide will see reimbursement reductions resulting from low HCI scores in coming years, she projected.
If they are not prepared, hospices will be in for a “rude awakening,” according to Stawasz. Providers need to keep up with any changes in quality measure requirements and ensure they are ready to comply.
“Now is the immediate time to start working on these measures if you haven’t done so. It’s almost too late already,” Stawasz said. “If you don’t pay attention to your quality scores now there are consequences of these measures having the potential to impact your reimbursement rate.”
The agency expects to begin public reporting of HCI scores and other hospice quality metrics this month, with annual updates each November.
The HCI measures will be implemented along with the Hospice Outcomes & Patient Evaluation (HOPE) tool, which is currently in its first stage of pilot testing. When complete, this will replace the current Hospice Item Set (HIS) quality reporting system.
These publicly reported quality data give consumers, payers and referral partners a picture of how a hospice measures up against its competitors.
A positive track record on quality puts providers in a better position when it comes to negotiating with payers, as well as catching the eye of new referral partners, Carol Javens, account manager at Acclivity Health, told Hospice News.
“It is vital to increase hospices’ understanding and management of these scores. These are going to be the biggest things payers look at when deciding who to contract with,” Javens said. “If you haven’t designed patient processes into these measures, you’re going to potentially miss out on the ability to engage with these contracts and potentially lose huge chunks of the population as these opportunities continue to expand.”
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