One crucial aspect for new hospice nurses to grasp is the Hospice Item Set (HIS) requirements. In this article, I’ll explain the HIS requirements for Medicare, providing a comprehensive understanding to ensure compliance and quality care delivery.
What is the Hospice Item Set (HIS)?
The Hospice Item Set (HIS) is a standardized data collection tool implemented by Medicare to assess the quality of care hospice agencies provide. It consists of several measures that capture essential patient information, symptom management, and overall patient experience. Hospice agencies routinely report these measures to Medicare.
Key HIS Requirements for Medicare
Understanding and fulfilling HIS requirements is crucial for hospice agencies to maintain compliance and eligibility for Medicare reimbursement. Here are key HIS requirements that new hospice nurses should be familiar with:
Initial Assessment Measure
The Initial Assessment Measure focuses on capturing comprehensive patient information during admission. Key components include:
Patient demographic data, including name, date of birth, and gender
Contact information for the patient’s primary caregiver or representative, including completing the bereavement risk assessments
Primary diagnosis : Remember that Medicare requires Medicare utilization for most terminal diagnoses. Use your Hospice Quick Flips as a guide.
Co-morbid conditions related to the terminal diagnosis
Pain assessment and management plan: Remember that if the patient has any medications for any pain, then pain is an Active Problem for the patient. A comprehensive pain assessment must be done for every admission and recertification, even if the patient is not having pain at the time of assessment.
Any patient having access to opioids must be on a bowel regimen. If the patient’s method is not an actual medication entered in the hospice MAR, such as “warm prune juice,” this must be documented in the admission note, including the IDG admission note.
Dyspnea (shortness of breath) assessment where if the patient is taking any medications (including having the availability of PRN medications) that help with dyspnea to answer the question, YES, they are short of breath.
Functional status includes the ability to perform activities of daily living and how this impacts mobility status. The palliative performance scale (PPS) measures the patient’s level of activity, self-care capacity, and intake.
The nutritional assessment and care plan include nutritional intake, appetite or weight loss/gain changes, and dietary restrictions or preferences.
Advance care planning discussions include end-of-life wishes, living wills, and healthcare power of attorney.
Psychosocial and emotional needs assessment, including any behavioral or mood changes, spiritual or cultural preferences, and support systems in place.
The patient’s calendar should include a post-admission visit within 48 hours of the admission and scheduled visits for social work and chaplain, for which the patient and family can refuse where such refusals need to be documented.
Please telephone the attending and the hospice medical director within 24 hours of the admission to obtain the verbal certificate of terminal illness (CTI) and ask if the attending will be following the patient and completing the PCP portion of the patient’s death certificate. If the provider does not follow the patient, follow your agency’s guidelines.
Comprehensive Assessment Measure
The Comprehensive Assessment Update is an ongoing process, with updates required at least every 15 days. This measure captures changes in the patient’s condition and ensures that the care plan is constantly updated to reflect the patient’s needs. Key components include:
HIS-CAHPS (Consumer Assessment of Healthcare Providers and Systems) Measure
HIS-CAHPS is a patient experience survey designed to evaluate the quality of care provided by hospice agencies. It includes questions related to:
Communication with healthcare providers
Emotional and spiritual support
Patient and caregiver involvement in care decisions
Overall satisfaction with the hospice experience
Importance of HIS Requirements for Medicare
Complying with HIS requirements is crucial for several reasons:
Eligibility for Medicare Reimbursement: Meeting HIS requirements is essential for hospice agencies to receive Medicare reimbursement for the care provided to eligible patients.
Quality Improvement and Performance Evaluation: The data collected through HIS helps evaluate and improve the quality of care hospice agencies provide. It enables identifying areas for improvement and implementing targeted interventions.
Regulatory Compliance: HIS requirements are aligned with federal regulations and guidelines. Adhering to these requirements ensures compliance with Medicare regulations and reduces the risk of penalties or loss of accreditation.
Enhanced Patient-Centered Care: HIS measures focus on comprehensive patient assessment, symptom management, and patient experience. Hospice agencies can provide patient-centered care that addresses individual needs and preferences by fulfilling these requirements.
Embracing HIS Requirements for Better Care
As hospice nurses, we are at the forefront of patient care and directly impact meeting HIS requirements. Here are some tips for embracing HIS requirements effectively:
Thorough Documentation: Accurately and comprehensively document patient assessments, interventions, and changes to support data collection and reporting.
Timely Data Entry: Prioritize timely data entry into the electronic health record (EHR) system to ensure accurate and up-to-date information for reporting purposes.
Collaboration and Communication: Foster effective collaboration and communication within the interdisciplinary team to ensure seamless data collection and submission.
Continuous Education: Stay updated on the latest HIS requirements and attend training sessions or workshops to enhance your understanding of data collection and reporting skills.
By embracing HIS requirements, we contribute to providing the best possible care for our hospice patients and their families while meeting regulatory standards.
Remember, you’re making a significant difference in the lives of those facing end-of-life journeys. Your compassion, expertise, and commitment are invaluable.
