Collecting data on any indicator will prepare you

Tweak reports, tools once rule is final

The only fact known about the quality reporting requirements described in the Proposed Wage Index Rule for FY2012 is that everything is proposed and might change before the final rule is published, according to Liz Silva, vice president of hospice for Deyta, a quality improvement and satisfaction measurement company based in Louisville, KY. Although this presents a challenge for hospice managers who are evaluating their QAPI programs to see what needs to be added or enhanced to enable compliance with reporting requirements, there are ways to make sure you're prepared, she suggests.

"No one can wait until every detail is final because a hospice manager needs to have time to evaluate the QAPI program and implement changes," Silva explains. If a hospice does need to bolster the QAPI program with additional measures, the AIM Project measures are a good place to start, she recommends. "CMS [Centers for Medicare and Medicaid Services] has invested time and money in the AIM Project so these measures or a variation of these measures will probably be included in quality reporting at some point," she says. "Even if the measure chosen by a hospice today is not included, all of the measures gather good information that will be helpful to the hospice."

The most important aspect of starting now to collect data and measure performance is to create a culture of quality reporting throughout the organization. "If your staff is accustomed to capturing and reporting data consistently, it will be easier to tweak your reports or your data collection tools if necessary to meet the final reporting requirements," Silva points out. "Starting now also gives the hospice time to feel comfortable with processes and data before reports must be submitted to CMS."

Although pain management within 48 hours of admission is a measure currently identified as the first clinical quality indicator for the CMS quality reporting program, there are several other valuable quality indicators, says Martha Lasseter, MBA, CHPCA, vice president of compliance for Treasure Coast Hospice in Stuart, FL. Because the state of Florida requires hospice to submit demographic and outcomes measures each year (see resource listing, right), her hospice staff is accustomed to collecting data, but as they worked with other measures included in the AIM Project, they discovered some gaps in data collection, she says.

"We were collecting data on dyspnea but we discovered that different nurses were using different dyspnea scales," explains Lasseter. A team of clinical directors evaluated existing scales that are available to determine which tool best fit the hospice's need, she says. Once the team decided upon the NYHA for Respiratory Distress, forms were revised to include the scale along with a standard set of questions for assessment, she says. "The same questions with boxes to check for answers are used by all staff members," she points out. "There is no subjective interpretation of the patient's symptoms and everyone uses the same language to document so it is simpler to pull data."

Anxiety is another symptom for which her hospice collects information, says Lasseter. "Often social workers initially document anxiety as they perform their psychosocial assessment, but follow-up notes to assess effectiveness of medication during the first two weeks after diagnosis may be made by any staff member," she says. "It was difficult to collect the data when we first started because we had to read the entire record, looking for notes related to anxiety." Not only was the information hard to find but every staff member used different language to document their assessment, she adds.

"Our solution was to develop anxiety assessment questions and place them in the same place on multiple forms used by social workers, nurses, certified nursing assistants, and chaplains," explains Lasseter. Data collected from the tool allows Lasseter to identify how many patients are determined to have anxiety, what percentage receive treatment, and if the anxiety is improved within two weeks. "Staff members like this approach because it is much simpler for them to check boxes rather than write out a note."