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Federal Register / Vol. 86, No. 147 / Wednesday, August 4, 2021 / Rules and Regulations
Figure 2: Percent of hospices meeting the public reporting threshold based on 1 FY
2019 or 2 pooled years FY 2018 to FY 2019 of data, by Hospice Care Index score
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Hospice Care Index Score

HCI Score 2019; n=4,155

HCI Score combined, small-missing hospices; n=277

Given these findings, we are finalizing our proposal to use 2 years of data to publicly report HCI and HVLDL in 2022.
The use of 2 years or 8 quarters of quality data is already publicly reported for the quality measures related to the CAHPS Hospice Survey so hospices are familiar with this approach. We plan to consider multiple years of data, like the 2 years of data, for other claims-based measures proposed in subsequent years.
We believe it is important to support consumers by sharing information on the performance of hospices that have lower scores, and to incentivize those hospices to improve. The results demonstrate that using multiple years of data help include more hospices that have lower performance rates for HVLDL and HCI in public reporting on Care Compare. While using more years of data would allow us to report measures for even more hospices, it would involve sharing data that are no longer relevant, and display scores that do not reflect recent hospice improvement efforts.
We solicited public comment on these proposals related to the use of 2 years of data for claims-based measures and public reporting of claims measures in general and their application to HVLDL
and HCI specifically. We received several comments from various stakeholders on this proposal. A
summary of the comments we received on this proposal and our responses to those comments appear below:

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Comment: A few commenters expressed concern that hospices would not be able to view data close to real time, which might inhibit the ability to use the score to inform continuous quality improvement.
Response: We agree that there is a lag time between the delivery of care and the calculation and reporting of the claims-based quality measures, including HCI. However, the time is needed. After the data extract is created after the 90-day run-off, it takes several months to incorporate other data needed for the calculations. We then need to generate and check the calculations before posting for confidential reporting.
Our proposal for using the 90-day runoff strikes a balance between allowing time for hospices to make corrections to their claims, while also seeking to post more rather than less up-to-date information. We have streamlined our processes as much as possible, and time is needed to go through these steps to ensure accurate publication of quality measure data.
Comment: Several commenters requested that CMS issue confidential reports with hospices claims-based measure scores in CASPER to help hospices understand and validate their scores before they are publicly reported.
Response: Section 1814i5E of the Act requires that the Secretary establish procedures for making HQRP data available to the public and ensure that hospices have the opportunity to review
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HQRP data before their release to the public. We will provide this opportunity to review for claims-based measures in a process similar to HISbased measures. Hospices can review and correct their HIS data before the Data Correction Deadline; for claims data, hospices will be able to ensure that the data are accurate through the end of the 90-day run-off period. Subsequently, as with HIS-based measures, we will implement a 30-day preview period for claims-based measures, which will serve as the final opportunity for hospices to review their data and alert CMS about any errors in the measure calculations they identify. Should a hospice believe they have found an error with an HIS or claims-based measure calculation as displayed in their preview reports, they can request a review, and we will suppress if the review finds the calculation problematic. We refer readers to the HQRP website at: https www.cms.gov/
Medicare/Quality-Initiatives-PatientAssessment-Instruments/HospiceQuality-Reporting/Public-ReportingHIS-Preview-Reports-and-Requests-forCMS-Review-of-HIS-Data, which we will revise to include further information on public reporting of claims as well as HIS data. This page covers information about for accessing reports and an email address should hospices have questions regarding any of the above-mentioned reports or processes.

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Source: 100% Medicare claims, Federal Fiscal Years 2018-2019.