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 you with 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 provided by hospice agencies. It consists of several measures that capture important patient information, symptom management, and overall patient experience. These measures are reported by hospice agencies to Medicare on a routine basis.

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 at the time of 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 most terminal diagnosis have requirements by Medicare for utilization. Use your Hospice Quick Flips as a .
  • Co-morbid conditions related to the terminal diagnosis
  • Pain assessment and management plan remembering that if the patient has any medications for any type of 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 and IF the method utilized by the patient is not an actual medication entered in the hospice MAR such as “warm prune juice,” this needs to be clearly documented in the admission note including IDG admission note.
  • Dyspnea () 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 including the ability to perform activities of daily living, how this impacts mobility status and the () such as the patient's level of activity, self-care capacity, and intake.
  • Nutritional assessment and care plan such as nutritional intake and any changes in appetite or weight loss/gain, as well as any dietary restrictions or preferences.
  • Advance care planning discussions such as end-of-life wishes, living wills, and healthcare power of attorney.
  • Psychosocial and emotional needs assessment such as 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 for which the patient and family can refuse where such refusals need to be clearly documented.
  • A telephone call to the attending and the hospice medical director within 24-hours of the admission to obtain the verbal certificate of terminal illness (CTI); and to also ask if the attending will be following the patient and completing the PCP portion of the patient's death certificate. If the provider will not follow the patient, then 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-Discharge Measure

The HIS-Discharge Measure captures relevant information when a patient is discharged from . Key components include:

  • Reason for discharge
  • Place of death
  • provided to the family
  • Evaluation of the care provided

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 provided by hospice agencies. 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. By fulfilling these requirements, hospice agencies can provide patient-centered care that addresses individual needs and preferences.

Embracing HIS Requirements for Better Care

As hospice nurses, we are at the forefront of patient care and have a direct impact on meeting HIS requirements. Here are some tips to embrace HIS requirements effectively:

  • Thorough Documentation: Document patient assessments, interventions, and changes accurately and comprehensively to support data collection and reporting.
  • Timely Data Entry: Prioritize timely entry of data 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 and skills in data collection and reporting.

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 , expertise, and commitment are invaluable.


Hospice Item Set (HIS)

Module 1 Hospice Item Set: General Information (video)

Hospice Quality Reporting Program Current Measures

An example recertification template for hospice eligibility

Hospice Routine Visit Template

Medicare Coverage of Hospice Care

Hospice Quality Reporting Program

Medicare Hospice Regulations

CMS Hospice Educational Resources

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