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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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Submission of Hospice Quality Reporting Program Quality Data using a web based data entry form
Olivia Berzin
Writer
2013-02-28
2026-09-16
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