The Hospice Item Set (HIS) Comprehensive Assessment at Admission captures whether multiple key care processes were completed upon patients' admissions to hospice. It is a single composite measure reflecting the following process measures: Treatment Preferences, and Beliefs/Values Addressed if desired by the patient, Pain Screening, Pain Assessment, Dyspnoea Treatment, Dyspnoea Screening, and Patients Treated with an Opioid who are Given a Bowel Regimen. As of FY2022, the seven process measures are no longer individually publicly reported. The composite measure is the only HIS measure reported. It is reported as an "all or none" measure. This single measure requires hospices to perform all seven care processes to receive credit.

All patient stays from the denominator who meet the numerator criteria for the individual components applicable to the patient. For the purposes of completing the HIS, a patient is considered admitted to a hospice if the following conditions are met: there is a signed election statement (or other agreement for care for non-Medicare patients); the patient did not expire before the effective date of the election or agreement for care; the hospice made a visit in the setting where hospice services are to be initiated.

Numerator specifications: The patient/responsible party was asked about preference regarding the use of cardiopulmonary resuscitation (F2000A = [1,2]) no more than 7 days prior to admission or within 5 days of the admission date (−7 ≤ F2000B − A0220 ≤ 5 and F2000B ≠ [–,^]) OR preferences regarding life-sustaining treatments other than CPR (F2100A = [1,2]) no more than 7 days prior to admission or within 5 days of the admission date (−7 ≤F2100B − A0220 ≤ 5 and F2100B ≠ [–,^]) OR preference regarding hospitalisation (F2200A = [1,2]) no more than 7 days prior to admission or within 5 days of the admission date (−7 ≤ F2200B − A0220 ≤ 5 and F2200B ≠ [–,^]) AND The patient and/or caregiver was asked about spiritual/existential concerns (F3000A = [1,2]) no more than 7 days prior to admission or within 5 days of the admission date (−7 ≤ F3000B − A0220 ≤ 5 and F3000B ≠ [–,^]) AND The patient was screened for pain within 2 days of the admission date (J0900B − A0220 ≤ 2 and J0900B ≠ [–,^]) and reported that they had no pain (J0900C = [0]) OR The patient was screened for pain within 2 days of the admission date (J0900B − A0220 ≤ 2 and J0900B ≠ [–,^]), the patient's pain severity was rated mild, moderate, or severe (J0900C = [1,2,3]), and a standardised pain tool was used (J0900D = [1,2,3,4]) AND* For a patient whose pain severity was rated mild, moderate, or severe (J0900C = [1,2,3]), a comprehensive pain assessment was completed within 1 day of the pain screening during which the patient screened positive for pain (J0910B − J0900B ≤ 1 and J0910B and J0900B ≠ [–,^]) and included at least 5 of the following characteristics: location, severity, character, duration, frequency, what relieves or worsens the pain, and the effect on function or quality of life (5 or more items in J0910C1 − J0910C7 checked and not all J0910C boxes = [–,^]) OR the patient reported that they had no pain during the pain screening (J0900C = [0]) AND The patient was screened for shortness of breath within 2 days of the admission date (J2030B − A0220 ≤ 2 and J2030B ≠ [–,^]) AND* For a patient that screened positive for shortness of breath (J2030C = [1]), the patient declined treatment (J2040A = [1]) OR Treatment for shortness of breath was initiated prior to the screening for shortness of breath or within 1 day of the screening for shortness of breath during which the patient screened positive for shortness of breath (J2040B − J2030B ≤ 1 and J2040B and J2030B ≠ [–,^]) OR the patient screened negative for shortness of breath (J2030C = [0]) AND† For a patient who had a scheduled opioid initiated or continued (N0500A= [1]), there is documentation of why a bowel regimen was not initiated or continued (N0520A = [1]) OR A bowel regimen was initiated or continued within 1 day of a scheduled opioid being initiated or continued (N0520B − N0500B ≤ [1] and N0520B and N0500B ≠ [– ,^]) OR the patient did not have a scheduled opioid initiated or continued (N0500A = [0]).

Other definitions required for reporting calculations: Admission Date (Item A0220): the date on which the hospice becomes responsible for the care of the patient. For Medicare patients, it is the same as the effective date of the hospice benefit election (or re-election), which may be the first day of hospice care or a later date, but may be no earlier than the date of the election statement. Discharge Date (Item A0270): the date a patient leaves the hospice. If the patient has expired, it is the date of death. For live discharges, it is the date the patient revoked the hospice benefit or the hospice plan of care or the date the hospice discharged the patient. Completion Date (Item Z0500B): the actual date on which the hospice completes the record. Defined as the date all required information has been collected and recorded, and staff have signed and dated that the record is complete. This date should represent the completion date for the HIS record that has been verified by the individual authorised to do so. This individual signs and dates Item Z0500. The completion date is recommended to be no later than the completion deadline. For HIS-Admission records: the recommended Completion Deadline is defined as the Admission Date + 14 calendar days. This means the Completion Date (Z0500B, the actual date on which the record was completed) is recommended to be no later than the Admission Date + 14 calendar days. The Completion Date can be equal to the Admission Date or Completion Deadline

All patient stays, except for those with exclusions.

Denominator exclusions: Patients younger than 18 (as indicated by the birth date (A0900) and admission date (A0220); Patients that have not been discharged from the hospice, as determined by the submission of a Hospice Item Set (HIS)-Discharge record; Discharged patients that do not have a matching HIS-Admission record. Hospices must have at least 20 patients in the denominator (i.e., 20 hospice admissions by patients at least 18 years of age) during the reporting period for measure scores to be publicly reported. Hospices that do not meet this threshold will have measure scores suppressed.

None

None

This quality measure is calculated from the Hospice Item Set (HIS) data submitted to CMS under the Hospice Quality Reporting Program (HQRP). All Medicare-certified hospice providers are required to submit HIS data on all patient admissions. Hospices submit two Hospice Item Set (HIS) records (a HIS-Admission record and a HIS-Discharge record) for each patient admission. Timing is not the same for all HIS records, as timing is based on the Admission Date or Discharge Date. Hospice Item Set (HIS) data collection consists of selecting responses to HIS items in conjunction with patient assessment activities or via abstraction from the patient's clinical record. HIS data may be collected on paper forms or using an electronic health record. The HIS may be completed by any hospice staff member, including volunteers, contractors, and affiliates (for example, staff from the quality division of the health system to which a hospice belongs). The hospice is responsible for the accuracy and completeness of information in the HIS. It is at the discretion of the hospice to determine who can accurately complete the HIS.

Public reporting

www.nhpco.org/regulatory-and-quality/quality/hospice-quality-public-reporting-hospice-compare/ User Manual: www.cms.gov/files/document/hqrp-qm-users-manual-v101aug2022.pdf HIS Manual: www.cms.gov/files/document/his-manual-v300022321.pdf Baker Rogers, J., & Cagle, J. (2024). Change in U.S. Hospice Quality Measure Scores During the COVID-19 Pandemic and Correlation With Exposure to State Policies for Protection of Older Adults. The American journal of hospice & palliative care, 41(7), 840–847. doi.org/10.1177/10499091231194726

www.cms.gov/files/document/hqrp-qm-users-manual-v101aug2022.pdf

Linked to NQF measure #3235