Overview
When you are viewing the Analyze page for a specific hospice, under the Quality and Operational tab, you can examine the Hospice Care Index (HCI) table. This table displays the success rate for the selected hospice against the CMS Hospice Care Index measures.
HCI evaluates each hospice on ten different indicators for which the hospice receives one point for each indicator where the hospice succeeds. A perfect score, therefore is a ten out of ten. For each performance indicator, the hospice must meet a specific level of success based on Medicare FFS claims in order to garner each point. The Hospice Care Index is one of the four measures that are use in the Hospice Quality Reporting Program (HQRP).
For a great overview of the HQRP measures, see Current Measures.
Understanding the Table
The easiest way to understand if we just look at the table:
HCI Indicator - This column includes the name for each Medicare Fee-for-Service claims-based indicator used to calculate the overall HCI score for the hospice.
Description - A description of the HCI indicator as defined by CMS.
These descriptions indicate the calculations used for each indicator. This is helpful when you look at the metrics for the selected hospice since the metrics in the "This Hospice" column vary between percentages and averages.
Criteria - This identifies the threshold for success for each HCI indicator. Meeting the listed criteria will give the hospice a single point for each indicator.
CMS and Trella Sections
The remaining columns have two main divisions; columns for the most recent CMS HCI metrics and the more recent metrics calculated from the claims by Trella Health. In short, Trella Health will always use the most recent data from the claims for the Trella Health section.
Compare - Since the Trella Health metrics are more recent, you can compare metrics in identical columns from each section to see if the metrics indicate a positive or negative trend for each indicator.
Example: Look at the row for the first metric, Continuous Home Care (CHC) or General Inpatient Care (GIP) Provided. The criteria is the percentage of hospice service days of the listed types, and the threshold for success is to be higher than 0%. The older CMS calculation is 3.5%, and the more recent Trella Health calculation is 2.45%. Since the general sense of this indicator is that the larger percentage is desirable, this dip in the percentage is indicative of a lapse in performance for this indicator.
Understanding the Metrics
Since the metrics are the same in each section, we will focus on the CMS set of columns.
This Hospice
The column displays the calculated metric for the indicator for the selected hospice.
In this row, the measure is the percentage of beneficiaries treated by the selected hospice who received a visit from a nurse or social worker during the last three days of life. The selected hospice had a percentage of 94.9% of patients who received visits during this period.
State
This is the average percentage of all beneficiaries in the state who received visits by a nurse or social worker during the last three days of life. For the state in which the hospice is located, the average was 94.2%. The selected hospice provided visits to a larger percentage of beneficiaries than the average for hospices in the state.
National
This metric is the average percentage of all beneficiaries in the country who received visits by a nurse or social worker during the last three days of life. The national average was 90.0%. The selected hospice provided visits to a larger percentage of beneficiaries than the national average.
Percentile Rank
This metric places the selected hospice on the scale in comparison to all other hospices in the nation for the specific indicator. The number is the percentile rank for the selected hospice among all hospices nationally. The 65 means that the selected hospice performed better than ~64 out of 100 hospices, and not as well as ~ 35 out of 100 hospices for the indicator listed in that row.
HCI Criteria Met (?)
This is a yes/no answer to the question, "Did the selected hospice meet the criteria set by CMS for this indicator?" In this case, the threshold set was to be "Above 10 Percentile Rank" which the selected hospice did by having a percentile rank of 65.
HCI Earned Points
Because the hospice met the threshold set by CMS for the indicator in the row, they get a 1 (one) in the "HCI Earned Points" column. If the hospice does not succeed, a 0 (zero) would be shown in this column for the failed indicator.
In the image above, we show the total for all indicators in the bottom row. Our selected hospice received a score of 10.
Using the Metric
Prove your success
If you look at this table for your own hospice, you can identify indicators for which your hospice has met and exceeded CMS standards for the HCI. The Trella Health team has often directed users to two indicators of especial interest to Medicare beneficiaries:
You can check these two row to see how well your agency has performed. Not only can you bring attention to meeting the CMS thresholds, if you are near the top of the Percentile Rank, that is a good indicator of excellent performance.
In addition, you can compare your actual performance for any indicator in comparison with the state or national averages.
Certainly you can use any of the indicators as a reference point if your hospice succeeds. It is also a nice talking point if you agency has a perfect score of 10 out of 10.
