Quality Metrics Decoder

Definition

Quality metrics are standardized measurements used by the Centers for Medicare & Medicaid Services (CMS) to evaluate how well hospice providers care for their patients.

What They Measure

These metrics tell you what percentage of patients receive specific types of evidence-based care—like pain screening, breathing management, and documented treatment goals.

Key Point

Higher scores (closer to 100%) generally indicate better quality care. These metrics are published publicly so you can compare hospices in your area.

CAHPS (Consumer Assessment of Healthcare Providers and Systems)

Patient and family satisfaction survey measuring overall hospice experience. Covers topics like communication with nurses, pain management, respect for patient wishes, and emotional support. Higher scores indicate families felt well-supported and cared for.

HVLDL (Hospice Visits in the Last Days of Life)

Measures the average number of hospice visits patients receive in their final week of life. More visits typically indicate better symptom management and family support during the dying process. Target: 8+ visits in the last 7 days.

HCI (Hospice Care Index for Pain and Breathing)

Composite measure tracking how well hospices screen for and treat pain and shortness of breath. These are two of the most distressing symptoms at end of life. Good scores (90%+) show consistent attention to symptom management.

HIS (Hospice Item Set - Treatment Preferences)

Percentage of patients whose treatment preferences and goals are documented. High scores (85%+) indicate the hospice regularly discusses what matters most to patients and ensures care aligns with their wishes.

HIS Composite Score (Overall Quality Rating)

Overall quality score combining multiple measures into a single 0-10 rating. Scores of 8 or higher are considered excellent. This provides a quick snapshot of overall hospice quality across pain, breathing, goals documentation, and visits.

Excellent: 90-100%

Hospice consistently provides high-quality care to nearly all patients.

Good: 80-89%

Hospice provides quality care to most patients, with room for improvement.

Fair: 70-79%

Some patients may not receive consistent care; ask what they're doing to improve.

Poor: Below 70%

Significant quality concerns; consider other providers if available.

Medicare Care Compare (medicare.gov/care-compare)

Official Medicare website for comparing hospices. Search by zip code to see quality ratings, patient satisfaction scores, and services offered by hospices in your area. The most comprehensive and reliable source.

State Health Department Websites

Many states publish additional hospice data including inspection reports, complaints, and enforcement actions. Check your state's health department website for hospice provider information.

Hospice Compare Data Archive

Historical quality data for tracking trends over time. Shows whether a hospice is improving or declining in quality measures. Available through the CMS website.

National Hospice and Palliative Care Organization (NHPCO)

Industry organization that provides information about hospice care standards and accreditation. Their website offers educational resources and a provider search tool.

Joint Commission and ACHC Accreditation

Third-party accreditation organizations that certify hospices meeting higher quality standards. Look for accreditation seals on hospice websites and marketing materials.

Check Multiple Metrics, Not Just One

Don't focus solely on one measure. A good hospice should score well across pain management, breathing care, treatment preferences, and visit frequency. Look for consistent quality across all areas.

Compare to National and Local Averages

National average is typically 70-80% for most measures. Look for hospices scoring at or above the national average. Also compare providers in your area to each other to find the best local option.

Look for Improvement Trends Over Time

Check if scores have improved, remained stable, or declined over the past 2-3 years. Upward trends show commitment to quality improvement. Declining scores may indicate staffing issues or management problems.

Ask Questions About Low Scores

If a hospice has low scores in certain areas, ask them directly: "Why is your pain management score at 75%?" and "What are you doing to improve?" Their response tells you a lot about their commitment to quality.

Consider Patient Complexity

Hospices serving more complex patients (cancer, dementia, advanced heart disease) may have slightly lower symptom control scores simply due to patient acuity, not poor care. Context matters.

Balance Metrics with Other Factors

Quality metrics are important but not the only consideration. Also evaluate location, services offered, staff availability, cultural fit, and whether they accept your insurance.

What are your current quality scores on Medicare Care Compare?

See if they're transparent about their performance. Good providers will readily share this information and explain what the scores mean.

How do your scores compare to other hospices in this area?

Shows whether they benchmark themselves against competitors. High-quality hospices know where they stand locally.

What are you doing to improve in areas where your scores are lower?

Every hospice has room for improvement. The best ones have specific quality improvement plans and can describe them clearly.

What percentage of your patients report being satisfied with care?

Even if not required to report CAHPS scores, they should track patient satisfaction internally. Ask for specific numbers, not vague statements.

How many visits can we expect in the final days of life?

The HVLDL metric measures this, but ask directly. More visits (8-12+) in the last week typically indicate better end-of-life support.

How do you ensure pain and breathing problems are managed 24/7?

Should describe specific protocols for symptom screening, medication management, and after-hours nurse availability.

Are you accredited by The Joint Commission or ACHC?

Third-party accreditation indicates the hospice has met higher quality and safety standards beyond basic Medicare certification.