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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations of patients who seek care at smaller hospices. However, due to the threshold, at least some hospices will not achieve the minimum patient stays within 1 year. This means that their scores will not be displayed on Care Compare, and consumers will not have information about them to inform their decisions about selecting a hospice.
Using more years of data allows more of these hospices to meet this threshold.
We conducted reportability testing for HCI and HVLDL to help us consider how best to balance the need for recent
data with the need for transparency in reporting the HQRP claims-based measures. Specifically, we conducted a simulation using 2 years of data. We then calculated the change in the number of hospices which achieved the minimum reporting standard. We also compared the measure scores of the hospices that meet the reporting threshold when we use 2 years of data with hospices that meet the threshold using only 1 year of data.
Results for both HCI and HVLDL
indicate that using 2 years of data
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increases reportability. For HVLDL, combining 2 years of data FY 2018 to FY 2019 allows an additional 326
hospices to share measure scores, or 33.8 percent of the hospices that do not meet the reporting threshold in FY 2019
alone. For HCI, combining 2 years of data FY 2018 to FY 2019 data allows an additional 277 to report HCI measure scores on Care Compare, or 43.2 percent of the hospices that do not meet the reporting threshold in FY 2019 alone.

TABLE 19: Two years of Data Increases Reportability for HVLDL and HCI

HVLDL
HCI

Excluded hospices Additional hospices meeting % of hospices that did not when using one year of threshold with two years of data meet threshold in FY 2019
data FY 2019 alone FY 2018 - FY 2019, relative to FY 2019 alone 33.8%
965
326
641
277
43.2%

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Our simulations indicate that the hospices that only meet the reporting threshold when using 2 years of data have performance scores substantially lower than average. For HVLDL, where higher scores indicate better quality of care, the national average score was 65.5
percent in FY 2019, where 965 hospices did not meet the reportability threshold.
After pooling data using FY 2018 to FY
2019, 326 additional hospices met the
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reportability threshold, or 33.8 percent of those previously missing. Those addition 326 hospices had an average HVLDL score of just 43.3 percent, about 20 percentage points lower than the hospices meeting the reportability threshold using FY 2019 alone national average score for this HVLDL measure.
The results for HCI similarly show that the hospices with reportable data when using two-pooled years of data
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had lower HCI scores compared to the national average when using just FY
2019 data. Higher HCI scores indicate better performance. As Figure 2 shows, a larger numbers of hospices among the 277 hospices that only meet the reporting threshold when using 2 years of data had HCI scores between four and eight, while a larger number of hospices in the FY 2019 population had a perfect score of 10.

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Quality Measure