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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations
TABLE 14: Reportability: Percent of Providers Meeting Measure Public R eporfmg Th res h 0 Id s Reportability Standard Public Reuorting SPR
Met threshold % Providers
COVID-19 Affected Reuorting CAR
Met Threshold % Providers
Measure
HIS Comprehensive Assessment Measure
4,078 89.1%

3,842 83.9%

Table 14 indicates that the reliability of the HIS Comprehensive Assessment Measure scores is similar for the CAR
and SPR scenarios. Testing also yielded correlation coefficients above 0.9, indicating a high degree of agreement between hospices HIS Comprehensive Assessment Measure scores when using
Difference CAR-SPR

3 or 4 quarters of data. The results also show that th e HIS Comprehensive Assessment Measures ICC for CAR and SPR scenarios are similar, with only a 0.02 difference. This implies high internal reliability of the measure in both scenarios. The median reliability scores for the HIS Comprehensive
-236 -5.2%

Assessment Measure are also very similar in both CAR and SPR scenarios.
This indicates that scores estimated using 3 quarters of data continue to capture provider-level differences and that admission-level scores remain consistent within hospices.

TABLE 15: Reliability: Correlations, Split-Half Testing, and Reliability Score for COVID-19 Affected CAR and Standard Public Reporting SPR
Scenarios Correlation between CAR and SPR
Measure
Pearson
Spearman
HIS
Comprehensive 0.98
0.96
Assessment Measure ICC = Intra-class Coefficient In Table 15, we explore changes in hospices relative rankings between the SPR and CAR scenarios. For each scenario, we divided hospices in quintiles based on their HIS
Comprehensive Assessment Measure
Split-Half Testin2:

Reliability Reliability Score
ICC
CAR

ICC
SPR

Difference CARSPR

Median Score CAR

Median Score SPR

Difference CARSPR

0.95

0.93

0.02

97.5

97.7

-0.2

score, such that higher scores are in a higher quintile. Changes in a hospices quintile from the SPR to CAR scenario would indicate a re-ranking of hospices when using 3 quarters compared to 4
quarters. Over 93 percent of hospices
remain in the same quintile, suggesting that the ranking of hospices is fairly stable between the SPR and CAR
scenarios.

Urban Providers
Measure
%Same Quintile
% CAR
Lower Quintile
% CAR
Higher Quintile
% Same Quintile
% CAR
Lower Quintile
% CAR
Higher Quintile
%Same Quintile
% CAR
Lower Quintile
% CAR
Higher Quintile
HIS
Comprehensive Assessment Measure
93.4%

2.4%

4.2%

93.5%

2.1%

4.4%

93.3%

2.5%

4.2%

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TABLE 16: Performance: Comparison of Quintile Rankings between COVID-19 PHE Affected CAR and Standard Public Reporting SPR Scenarios