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Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form
ICR 201307-0938-020 · OMB 0938-1153 · Object 41178801.
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form |
| Author | Olivia Berzin |
| Last Modified By | Writer |
| File Modified | 2013-02-28 |
| File Created | 2026-09-16 |
| Conversion State | complete |
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General Changes Change Rationale The Hospice Data Submission Form is renamed Hospice Item Set. The Hospice Data Submission Form - NQF #0209 Pain Measure is renamed Hospice Item Set - Admission. The Hospice Data Submission Form - Structural Measure is renamed Hospice Item Set - Discharge. Retiring non-NQF-endorsed structural measure and NQF #0209 Pain Measure. Replacing items related to these measures with items needed to calculate newly endorsed quality measures. Items Eliminated/Replaced Section or Item Form Rationale Facility Provider Identification Structural Measure, NQF #0209 Pain Measure A0100 Facility Provider Numbers replaces this item (see Items Added). The change is needed for item harmonization across item sets. Part 1. Structural Measure Structural Measure Retiring non-NQF-endorsed quality measure. Q1. Does your hospice have a Quality Assessment and Performance Improvement (QAPI) program that includes three or more quality indicators related to patient care? Structural Measure Retiring non-NQF-endorsed quality measure Q2. If your hospice’s QAPI program includes at least one patient care related quality indicator, include each indicator using the form provided below. Structural Measure Retiring non-NQF-endorsed quality measure Q3. Please indicate the data source(s) for your QAPI indicators. Structural Measure Retiring non-NQF-endorsed quality measure Part 2. NQF #0209 Pain Measure NQF #0209 Pain Measure Retiring NQF #0209 Pain Measure. Items in this section will be replaced with items J0900 Pain Screening and J0910 Comprehensive Pain Assessment which are needed to calculate newly endorsed quality measures addressing pain (See Items Added). 1. Enter the number of admissions during the data collection period (October 1, 2012 through December 26, 2012) NQF #0209 Pain Measure Retiring NQF #0209 Pain Measure. 2. Pain Measure Denominator: Enter the number of patients who answered YES to the question “are you uncomfortable because of pain?” at the initial assessment (after admission to hospice services) during the data collection period NQF #0209 Pain Measure Retiring NQF #0209 Pain Measure. Items Eliminated/Replaced Section or Item Form Rationale 3. Enter the number of patients who answered NO to the question “are you uncomfortable because of pain?” at the initial assessment (after admission to hospice services) during the data collection period NQF #0209 Pain Measure Retiring NQF #0209 Pain Measure. 4. Enter the number of patients excluded. NQF #0209 Pain Measure Retiring NQF #0209 Pain Measure. 5. Pain Measure Numerator: Enter the number of patients who answered YES to the question “ was your pain brought to a comfortable level within 48 hours of the start of hospice care?” during the data collection period NQF #0209 Pain Measure Retiring NQF #0209 Pain Measure. 6. Enter the number of patients who answered NO to the question “ was your pain brought to a comfortable level within 48 hours of the start of hospice care?” during the data collection period NQF #0209 Pain Measure Retiring NQF #0209 Pain Measure. 7. Enter the number of patients unable to self report at follow up. NQF #0209 Pain Measure Retiring NQF #0209 Pain Measure. Attestation Structural Measure, NQF #0209 Pain Measure Item Z0400 Signature(s) of Person(s) Completing the Record and Item Z0500 Signature of Person Verifying Record Completion replace this item (see Items Added). The change is needed for item harmonization across item sets. Authorization for Hospice QRP Data Entry Structural Measure, NQF #0209 Pain Measure This item was for paper submissions. Going forward all submissions will be electronic. Items Added Section or Item Number Section or Item Name Form Rationale Section A Administrative Data Admission, Discharge Items in this section are needed for record matching and management or to calculate newly endorsed quality measures. A0050 Type of Record Admission, Discharge Needed for record matching and management A0100 Facility Provider Numbers Admission, Discharge This item replaces the Facility Provider Identification section (see Items Eliminated/Replaced). It is needed for record matching and management. Items Added Section or Item Number Section or Item Name Form Rationale A0205 Site of Service at Admission Admission, Discharge Needed for quality measure maintenance and for harmonization with other item sets A0220 Admission Date Admission, Discharge Needed for record matching and management and to calculate newly endorsed quality measures. A0245 Date Initial Nursing Assessment Initiated Admission Needed to calculate newly endorsed quality measures A0250 Reason for Record Admission, Discharge Needed for record matching and management A0270 Discharge Date Discharge Needed for record matching and management and to calculate newly endorsed measures. A0500 Legal Name of Patient Admission, Discharge Needed for record matching A0600 Social Security and Medicare Numbers Admission, Discharge Needed for record matching A0700 Medicaid Number Admission, Discharge Needed for record matching A0800 Gender Admission, Discharge Needed for record matching A0900 Birth Date Admission, Discharge Needed for record matching A1000 Race/Ethnicity Admission Needed for quality measure maintenance and for harmonization with other item sets A1802 Admitted From Admission Needed for quality measure maintenance and for harmonization with other item sets A2115 Reason for Discharge Discharge Needed for quality measure maintenance and for harmonization with other item sets Section F Preferences Admission Items in this section are needed to calculate newly endorsed quality measures. F2000 CPR Preferences Admission Needed to calculate newly endorsed quality measure F2100 Other Life-Sustaining Treatments Preferences Admission Needed to calculate newly endorsed quality measure F2200 Hospitalization Preference Admission Needed for ease of use of item set and for measure maintenance. Items Added Section or Item Number Section or Item Name Form Rationale F3000 Spiritual/Existential Concerns Admission Needed to calculate newly endorsed quality measure Section I Active Diagnoses Admission The item in this section is needed for quality measure maintenance and to harmonize with other item sets I0010 Principal Diagnosis Admission Needed for quality measure maintenance and to harmonize with other item sets Section J Health Conditions Admission The items in this section are needed to calculate newly endorsed quality measures. Some will replace the NQF #0209 Pain Measure items. They are needed to calculate newly endorsed quality measures addressing pain and shortness of breath for hospice patients. J0900 Pain Screening Admission Needed to calculate newly endorsed quality measures J0910 Comprehensive Pain Assessment Admission Needed to calculate newly endorsed quality measure J2030 Screening for Shortness of Breath Admission Needed to calculate newly endorsed quality measure J2040 Treatment for Shortness of Breath Admission Needed to calculate newly endorsed quality measure Section N Medications Admission The items in this section are needed to calculate newly endorsed quality measures. N0500 Scheduled Opioid Admission Needed to calculate newly endorsed quality measure N0510 PRN Opioid Admission Needed to calculate newly endorsed quality measure and for ease of use of item set and for measure maintenance. N0520 Bowel Regimen Admission Needed to calculate newly endorsed quality measure Section Z Record Administration Admission, Discharge The items in this section are needed for record management. They replace the Attestation item. Z0400 Signature(s) of Person(s) Completing the Record Admission, Discharge Needed for record management Z0500 Signature of Person Verifying Record Completion Admission, Discharge Needed for record management