Hospice Quality Measurement: A Mixed-Methods Approach to Assessing U.S. Hospices' Preparation for and Attitudes Towards Implementation of Mandated Public Reporting
Open AccessThe Affordable Care Act requires CMS to implement a public reporting program for hospice quality. Little is known about U.S. hospices' attitudes toward implementation of the program. A total of 1,451 hospices were recruited to respond to a web-based survey about their preparation for and perceptions of the need for CMS reporting in 2012. Three hundred and ninety hospices (26.9%) responded. Data from the cross-sectional survey were used to generate a series of multinomial regression models. Outcomes of interest were (1) the need for CMS reporting and (2) willingness to participate in a voluntary public reporting program. Predictor variables were hospice size, tax status, electronic medical record implementation, and current use of the Family Evaluation of Hospice Care Survey. Content analysis of 15 semi-structured interviews with non-provider stakeholders augmented survey data. Hospices are prepared to comply with the public reporting mandate and the majority (71.5%) believes CMS reporting is needed. Not-for-profit hospices were more likely to say CMS reporting is needed (OR for for-profits relative to not-for-profits: 0.478; 95% CI: 0.237 - 0.965). Accounting for all other covariates, relative to hospices that had fully implemented electronic medical records, hospices that had not begun implementing an electronic medical record were significantly more likely to say CMS reporting is not needed (OR = 2.581; 95% CI: 1.069 - 6.230). CMS should continue its deliberate approach to implementation while taking this time to experiment with different ways of facilitating the industry's comfort with selected measures and how the data are presented to the public.
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