The percentage of hospice stays, of at least 30 days, where the patient experienced at least one gap between nursing visits exceeding 7 days.

The number of stays with the hospice where the patient experienced at least one gap between skilled nursing visits (i.e., those from a registered nurse or licensed practical nurse) exceeding seven days.

Claims-based calculation details: Days of hospice service are identified based on the presence of revenue centre codes 0651 (RHC), 0652 (CHC), 0655 (IRC), and 0656 (GIP) on hospice claims; Identify the dates billed for 0651 (RHC), 0652 (CHC), 0655 (IRC), and 0656 (GIP) by examining the corresponding revenue centre date (which identifies the first day in the sequence of days by level of care) and the revenue centre units (which identify the number of days (including the first day) in the sequence of days by level of care); Identify the dates billed for Continuous Home Care by examining the revenue centre date; A hospice stay is defined as a sequence of consecutive days for a particular beneficiary that are billed under the hospice benefit. A gap of at least one day without hospice ends the sequence. Nursing visits are identified if any of the following criteria are met: The presence of revenue centre code 055x (Skilled Nursing) on the hospice claim. The date of the visit is recorded in the corresponding revenue centre date. This code includes both registered nurse and licensed practical nurse visits; The presence of revenue code 0652 (Continuous Home Care) on the hospice claim. Therefore, we assume any day with Continuous Home Care care also included nursing visits, even if not explicitly recorded; The presence of revenue code 0656 (General Inpatient Provided) on the hospice claim. Because Medicare does not require hospices to record all visits on the claim for the General Inpatient Provided level of care, we assume that days billed as GIP will include nursing visits even if not explicitly recorded. Based on the above information, if within a hospice stay, there are eight or more consecutive days where no nursing visits are provided, no CHC is provided, and no GIP is provided, then the hospice stay is identified as having a gap in nursing visits greater than seven days. For each hospice, the number of stays with at least one gap of eight or more days without a nursing visit (for stays of 30 or more days) is divided by the number of stays of 30 or more days.

The total number of stays with the hospice.

Hospice stays that include less than 30 consecutive days of hospice are excluded.

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Data Source: Hospice Medicare claims data. Data are obtained from provider submitted claims for the information needed to calculate the measure, so providers do not submit any additional data to CMS. CMS will use 2 years of Medicare claims data (8 quarters) to calculate the measure. The ten indicators contribute to the HCI score as follows: Each HCI indicator has its own numerator, denominator, and resulting indicator score. A hospice's given indicator score relative to an Index Earned Point Criterion determines whether the hospice earns a point for that indicator towards the full index score; Index Earned Point Criteria were set based on CMS' statistical analysis of national hospice performance to ensure meaningful distinction between hospices; Hospices' HCI scores are calculated as the total number of Index Earned Points across the ten indicators and can range from a perfect 10 to a 0. All hospices with at least 20 claims during the sample period have indicator scores calculated.

Public reporting.

Hospice Care Index Technical Report: www.cms.gov/files/document/hospice-care-index-hci-technical-reportjuly-2022.pdf. Date cited 12/10/23. CMS Current Measures: www.cms.gov/medicare/quality/hospice/current-measures. Date cited 12/10/23.

www.cms.gov/files/document/hqrp-qm-users-manual-v100oct2021.pdf

This measure is linked to the Hospice Care Index (HCI) measure.