Hospice exclusion in NCQA measures is hard to implement, many patients are not being excluded who should be

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    • Type: Implementation Problem
    • Resolution: Done
    • Priority: Moderate
    • Component/s: None
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      Receipt of palliative care is not necessarily equivalent to a patient being in hospice. Patients may get palliative care encounters when not close to end of life, and these individuals should not be counted as meeting the hospice criteria for exclusion. NCQA is exploring exclusions in some measures for patients that have advanced illness and may be receiving palliative care.
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      Receipt of palliative care is not necessarily equivalent to a patient being in hospice. Patients may get palliative care encounters when not close to end of life, and these individuals should not be counted as meeting the hospice criteria for exclusion. NCQA is exploring exclusions in some measures for patients that have advanced illness and may be receiving palliative care.
    • Exclusion population too low

      The hospice exclusion for measures for which NCQA is the steward is hard to implement, with the result being that some patients are not being excluded but should be, based on them being in hospice or palliative care.

      In current measures, exclusion is only possible if patient records have evidence of an intervention for hospice care ordered or performed, or if records include an inpatient discharge to hospice. Also, the value set for the intervention contains only two codes.

      Please refer to the limitations of this specification discussed in CQM-2437 and also a recommendation to include palliative care data to broaden the exclusion, and to allow for the counting of the ICD-10 Z-code Z51.5 as discussed in CQM-2139.

      As currently specified, provider organizations are reporting to us that patients are not being excluded using the normal workflows that clinicians are using, requiring them to train clinicians in extra documentation just to indicate that the patient is in hospice care, which often does not work a as clinicians are just not doing this extra documentation.

      We ask NCQA to re-evaluate their approach.

            Assignee:
            Mathematica EC eCQM Team (Inactive)
            Reporter:
            Howard Bregman (Inactive)
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              Created:
              Updated:
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