The Hospice Care Index (or HCI) is an index measure; it scores hospices on a 0 to 10 scale using ten Medicare claims-based indicators which capture a broad array of information on hospice service provision. The HCI provides information that reflects care processes during a hospice stay and allows patients, families, and caregivers to make informed decisions. Collectively these indicators represent different aspects of hospice service and thereby characterize hospices comprehensively, rather than on just a single care dimension. Each indicator equally affects the single HCI score, reflecting the equal importance of each aspect of care delivered from admission to discharge.

The Hospice Care Index (HCI) does not have a traditional numerator statement. Instead, a hospice is awarded a point for meeting each criterion for each of the ten claims-based indicators. The sum of the points earned from meeting the criterion of each individual indicator results in the hospice's HCI score. HCI scores can range from 0 to a perfect 10. The ten indicators include: Continuous Home Care (CHC) or General Inpatient (GIP) Provided; Gaps in Skilled Nursing Visits; Early Live Discharges; Late Live Discharges; Burdensome Transitions (Type 1) – Live Discharges from Hospice Followed by Hospitalisation and Subsequent Hospice Readmission; Burdensome Transitions (Type 2) – Live Discharges from Hospice Followed by Hospitalisation with the Patient Dying in the Hospital; Per-beneficiary Medicare Spending; Skilled Nursing Care Minutes per Routine Home Care (RHC) Day; Skilled Nursing Minutes on Weekends; Visits Near Death.

The Index Earned Point Criterion for each of the ten individual indicators are: Hospices earn a point towards the Hospice Care Index if they; provided at least one Continuous Home Care (CHC) or General Inpatient (GIP) Provided service day within a reporting period; if their individual hospice score for gaps in skilled nursing visits greater than seven days falls below the 90th percentile ranking among hospices nationally; if their individual percentage of live discharges on or before the seventh day of hospice falls below the 90th percentile ranking among hospices nationally; if their individual hospice score for live discharges on or after the 180th day of hospice falls below the 90th percentile ranking among hospices nationally; if their individual hospice score for Type 1 burdensome transitions falls below the 90th percentile ranking among hospices nationally; if their individual hospice score for burdensome transitions (Type 2) falls below the 90th percentile ranking among hospices nationally; if their average Medicare spending per beneficiary falls below the 90th percentile ranking among hospices nationally; if their individual hospice score for Nursing Minutes per RHC day falls above the 10th percentile ranking among hospices nationally; if their individual hospice score for percentage of skilled nursing minutes provided during the weekend is above the 10th percentile ranking among hospices nationally; if their individual hospice score for percentage of decedents receiving a visit by a skilled nurse or social worker in the last three days of life falls above the 10th percentile ranking among hospices nationally.

The Hospice Care Index (HCI) does not have a traditional denominator. The HCI score is calculated as the total number of points earned across ten indicators (hospices earn a point on an indicator when their indicator scores meet the criterion for the given indicator). The potential range of scores is from 0 to 10.

Denominator exclusions: Hospices with fewer than 20 discharges in the two pooled years of data are not assigned a calculated index score per the convention of CMS's quality reporting program (requiring sufficient data available to calculate reliable scores for publicly displayed measures).

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The Hospice Care Index (HCI) score and percentage of hospices achieving a score of 10 by various characteristics such as: the decade by which the hospice was certified to first provide Medicare services (1980s, 1990s, 2000s, and 2010s); ownership status (government-owned, non-profit, for-profit); facility type (freestanding, facility-based); Census region (Northeast, Midwest, South, and West) and urban vs. rural status. Using Medicare hospice claims, the CMS also measure the number of claims submitted by the hospice to create strata (20-49, 50-79, 80-199, 200- 499, and 500+ treated in the target year).

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/hospice-care-index-hci-technical-reportjuly-2022.pdf