CAHPS Five Star Rating

Members were joined by staff from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey team at the Centers for Medicare and Medicaid Services (CMS) to review the implementation of the new hospice Five Star Rating. This first ever Five Star Rating for hospices will debut on Hospice Compare in August 2022. A dry run of the Five Star Rating was sent to hospices in November 2021 and March 2022. The star ratings are “top box scores”, which reflect the proportion of respondents who gave the most positive response(s) adjusted for case-mix of patients and the mode of survey administration (phone or mail). There will also be an overall star rating referred to as the “Family Caregiver Survey Rating”. This is calculated using a weighting system for each measure of the survey. The CAHPS team’s presentation included resources for hospice providers to review their rating before the August launch. The star ratings will be updated every six months and an appeals process is available by contacting the CAHPS team directly when the provider preview reports are released, typically several months prior to public release. A copy of the presentation is available here.

In addition to reviewing the Five Star Rating methodology and resources, staff also reiterated that starting with FY2024, the penalty for hospices that do not report quality data to CMS is a 4% points reduction in the Annual Payment Update (APU). CAHPS hospice survey compliance in CY2022 will affect FY2024 APU.

Members discussed the challenges they face with the current survey and hopes for future improvement. Several mentioned that the current mode of conducting the survey (phone or mail) does not reach everyone eligible and many struggled to increase their responses. The CAHPS team agreed that did limit response and shared they had just completed a mode experiment looking at delivery of the survey via email. They also shared the team is looking at revising and shortening the survey which is currently 47 questions. Providers asked if CMS had considered surveying the patients directly about their care while in hospice. CMS shared that it did not feel appropriate to survey beneficiaries in the process of end of life. Others shared concerns about the timing of the survey, specifically that it was too far out for family members to respond about the care their loved ones received. CMS shared it would be something to consider in the future, but it also needs to be appropriate timing for families who are grieving.

Aging Services Workforce Now

Andrea Price-Carter Director, Workforce and Technology Policy to discuss a new LeadingAge policy initiative on workforce launched in July call Aging Services Workforce Now. The campaign includes a congressional briefing on the aging workforce, virtual lobby visits before the Labor Day holiday, and a day of action which will encourage members to reach out to their federal elected representatives to enact proposals, support legislation, and move appropriations to support the aging services workforce.

In addition to this campaign, LeadingAge conducted a snap poll of members to get a better sense of the workforce barriers they were facing. Overall, 60% of respondents said the staffing shortages were still causing issues for members. The most sighted reasons for staff leaving were better pay, working hours, and leaving the industry completely. Hospice represented 12% of respondents and were the third highest group responding that the workforce shortage was “severe”. An article reviewing of the snap poll results is available here.

Andrea discussed other barriers hospices have been facing during the workforce crisis including price gouging from travel nursing agencies. She shared that legislation in Congress, and as part of LeadingAge’s campaign asks, would seek to study the impact of these agencies on the health care industry. She also shared more state-based advocacy could be taken up on the issue.

Members shared one of the major issues they faced were the limits of scope of practice in each state. Many shared that they felt hospice aides were held back from doing the right thing for patients because of the requirements to check in with supervising nurses first. The same was echoed for licensed practical nurses (LPN), who are prohibited in many states from working with IVs without in-person supervision from a registered nurse. Many saw these scope issues as limiting their agency’s ability care for patients. Others shared they would like to see state run hiring clearinghouses which require employers to report hire/terminations of any licensed person.

Policy Update

FY2023 Hospice Wage Index Rule: The FY2023 Hospice Wage Index Final Rule went to the Office of Management and Budget (OMB) on July 7^th. This is the final step in the process before publishing. Staff expect to see the final rule published by the end of July and will keep providers posted on the contents.

Health Equity Technical Expert Panel: In July, CMS announced the formation of a Technical Expert Panel (TEP) to work on a structural composite measure for health equity in both home health and hospice. LeadingAge encouraged CMS to pursue a TEP in its comments on the FY2023 proposed rule. Staff asked for any members interested in applying to be part of the TEP to reach out to Katy Barnett (kbarnett@leadingage.org).  

Senate to Move on Appropriations: Senate Democrats are planning to release FY23 appropriations bills by the end of July, regardless of whether these bills are the result of bi-partisan negotiations. This would be a break from the Senate’s FY22 process when Democrats and Republicans worked together to develop the Senate FY22 bills before they were released.

Action Alert for Medicare Funding: Staff shared an action alert with members regarding recent funding cuts, and minimal payment increases, to Medicare services. LeadingAge members remain on the front line of the COVID-19 pandemic during one of the most difficult times in our country. Members need the Biden Administration and Congress to act on behalf of aging services providers and strengthen the infrastructure for providing quality care and services to our older adults.

CMS Provides June Open Door Forum: On June 29, CMS hosted an Open Door Forum for Home Health, Hospice and Durable Medical Equipment (DME) providers. CMS included several updates for the hospice quality reporting program during the call. Staff encouraged members to review the key announcements made during the call here.