5458 Federal Register / Vol. 78, No. 17 / Friday, January 25, 2013 / Notices

DEPARTMENT OF HEALTH AND most effective prevention and treatment limiting illness no longer responds to cure- HUMAN SERVICES practices for the leading causes of oriented treatments.2 mortality, starting with cardiovascular The National Hospice and Palliative Centers for & Medicaid disease; (5) working with communities Care Organization (NHPCO), a leading Services to promote wide use of best practices to organization for hospice providers, [CMS–4172–NC] enable healthy living; and (6) making describes hospice care as follows: quality care more affordable for The focus of hospice relies on the belief Medicare Program; Request for individuals, families, employers, and that each of us has the right to die pain-free Information To Aid in the Design and governments by developing and and with dignity, and that our loved ones Development of a Survey Regarding spreading new delivery will receive the necessary support to allow us and Family Member/Friend models.’’ to do so.3 Experiences With Hospice Care The survey, now under development, The planned CMS Hospice Survey hereinafter referred to as the ‘‘Hospice differs from other CMS patient AGENCY: Centers for Medicare & Survey’’ supports the National Quality Medicaid Services (CMS), HHS. experience surveys because the target Strategy goal of Better Care and the population for the Hospice Survey is ACTION: Request for information. priorities of— bereaved family members or close • Ensuring that each person and friends of who died in hospice SUMMARY: This document is a request for family are engaged as partners in their care. The reasons for focusing on family information regarding patient and care (priority #2); and members/friends are that the patient is family member or close friend • Promoting effective communication not the best source of information for experiences with hospice care. and coordination of care (priority #3). the entire trajectory of hospice care, and DATES: The information solicited in this The Centers for Medicare & Medicaid notice must be received at the address Services (CMS) has previously that many hospice patients are very ill provided below by March 26, 2013. implemented national surveys called and unable to answer survey questions. Given the unique environment and Consumer Assessment of Healthcare ADDRESSES: In responding to this patient population of hospice care, Providers and Systems (CAHPS®) solicitation please reply via email to existing patient experience instruments surveys in both in-patient and out- [email protected] or by designed for other settings are only patient settings and for different postal mail at Centers for Medicare and partially relevant for capturing hospice services. Specifically, CMS has Medicaid Services, Attention: Debra care experiences. A rigorous, well- implemented CAHPS® surveys for Dean-Whittaker, Mailstop C1–25–05, designed Hospice Survey will allow us Medicare health and drug plans, 7500 Security Boulevard, Baltimore, MD to understand: (1) Patient experiences inpatient , and home health 21244–1850. throughout their hospice care, as agencies. CMS and the Agency for FOR FURTHER INFORMATION CONTACT: reported by their family members/ Healthcare Research and Quality Debra Dean-Whittaker, 410–786–0848 friends; and (2) the perspectives of (AHRQ) have also developed CAHPS® SUPPLEMENTARY INFORMATION: family members/friends with regard to surveys for in-center hemodialysis their own experiences with hospice. I. Background facilities, nursing homes, and clinician This information will ultimately be used and group practices. None of these In accordance with section 3011 of to help improve the quality of care CAHPS® surveys address experiences the Affordable Care Act, the Department patients and their families and friends with hospice services. of Health and Human Services (HHS) receive in hospice. Hospice focuses on caring for patients developed the National Quality Strategy We are in the process of reviewing at the end of their lives and on helping to create national aims and priorities to potential topic areas, as well as publicly their families. In the Federal Register guide local, state, and national efforts to available instruments and measures, for we have defined hospice and hospice improve the quality of health care. The the purpose of developing a Hospice care as follows: National Quality Strategy established Survey that will enable objective Hospice means a public agency or three aims supported by six priorities. comparisons of hospice experiences private organization or subdivision of The three aims are as follows: across the country. This survey will be either of these that is primarily engaged • Better Care: Improve the overall used to help consumers make more in providing hospice care as defined in quality, by making health care more informed decisions about providers, as this section. patient-centered, reliable, accessible, well as provide information to drive and safe. Hospice care means a comprehensive set of improvements in the quality of hospice • Healthy People/Healthy services described in section 1861(dd)(1) of care. The principal focus of this effort is Communities: Improve the health of the the Act, identified and coordinated by an to develop a survey of family members U.S. population by supporting proven interdisciplinary group to provide for the physical, psychosocial, spiritual, and or friends who are 18 years of age and interventions to address behavioral, emotional needs of a terminally ill patient older and who are knowledgeable about social, and environmental determinants and/or family members, as delineated in a the care provided to the person enrolled of health in addition to delivering specific patient plan of care.1 in hospice. higher-quality care. The Hospice Foundation of America • Affordable Care: Reduce the cost of II. Solicitation of Information is one of many private organizations quality health care for individuals, We are soliciting the submission of that agree with the following statement: families, employers, and government. suggested topic areas (such as The six priorities are: ‘‘(1) Making Hospice is a special concept of care ‘‘communication with providers,’’ ‘‘pain care safer by reducing harm caused by designed to provide comfort and support to the delivery of care; (2) ensuring that patients and their families when a life- 2 Hospice Foundation of America, accessed each person and family are engaged as November 2, 2012 http://www.hospicefoundation. 1 42 CFR 418.3 Accessed November 19, 2012 org/whatishospice. partners in their care; (3) promoting http://www.gpo.gov/fdsys/pkg/CFR-2011-title42- 3 Caring Connections, accessed November 1, 2012 effective communication and vol3/xml/CFR-2011-title42-vol3-part418.xml# http://www.caringinfo.org/i4a/pages/index.cfm? coordination of care; (4) promoting the seqnum418.3. pageid=3356.

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control’’ or ‘‘non-pain symptom respondents to ensure that they DATES: The information solicited in this management,’’ as well as publicly understand the questionnaire.) notice must be received at the address available instruments for capturing ++ Results of field testing. provided below by March 26, 2013. family members’ or friends’ experiences ++ Current use of the instrument (who ADDRESSES: In responding to this with hospice care. We are interested in is using it, what it is being used for, solicitation, please reply via email to instruments and items that can measure what population it is being used with, [email protected] or by quality of care from the family member/ how instrument findings are reported, postal mail at Centers for Medicare and friend’s perspective, including all and by whom the findings are used). Medicaid Services, Attention: Memuna potential hospice settings (for example, ++ Relevant peer-reviewed journal Ifederah, Mailstop C1–25–05, 7500 home, nursing home, , and free- articles or full citations. Security Boulevard, Baltimore, MD ® standing hospice) and instruments that ++ CAHPS trademark status. 21244–1850. track changes over time. ++ National Quality Forum (NQF) FOR FURTHER INFORMATION CONTACT: We are looking for suggested topic endorsement status. Memuna Ifederah, (410) 768–6849 or areas and publicly available instruments ++ Survey administration instructions. Caren Ginsberg (410) 786–0713. in which the information was identified ++ Data analysis instructions. SUPPLEMENTARY INFORMATION: by family members/friends as important ++ Guidelines for reporting survey data. to them in evaluating hospice care. CMS is developing this survey and I. Background Existing instruments are preferred if plans to submit it to AHRQ for In accordance with section 3011 of they have been tested, have a high recognition as a Consumer Assessment the Affordable Care Act, the Department degree of reliability and validity, and of Healthcare Providers and Systems of Health and Human Services (HHS) report evidence of wide use. (CAHPS®) survey. The survey will be ® developed the National Quality Strategy The following information would be developed in accordance with CAHPS to create national aims and priorities to especially helpful in any comments Survey Design Principles and guide local, state, and national efforts to responding to this request for implementation instructions will be ® improve the quality of health care. The information: based on those for CAHPS instruments National Quality Strategy established • A brief cover letter summarizing the (https://www.cahps.AHRQ.gov/About- three aims supported by six priorities. information requested for submitted CAHPS/Principles.aspx). The 3 aims are as follows: instruments and topic areas, (Catalog of Federal Domestic Assistance • Better Care: Improve the overall respectively, and how the submission Program No. 93.773, Medicare—Hospital quality, by making health care more will help fulfill the intent of the survey. Insurance; and Program No. 93.774, patient-centered, reliable, accessible, • (Optional) Information about the Medicare—Supplementary Medical and safe. person submitting the material for the Insurance Program) • Healthy People/Healthy purposes of follow up questions about Dated: December 5, 2012. Communities: Improve the health of the the submission which includes the Marilyn Tavenner, U.S. population by supporting proven following: Acting Administrator, Centers for Medicare interventions to address behavioral, ++ Name. & Medicaid Services. social, and environmental determinants ++ Title. [FR Doc. 2013–01299 Filed 1–24–13; 8:45 am] of health in addition to delivering ++ Organization. BILLING CODE 4120–01–P higher quality care. ++ Mailing address. • Affordable Care: Reduce the cost of ++ Telephone number. quality health care for individuals, ++ Email address. DEPARTMENT OF HEALTH AND families, employers, and government.1 ++ Indication that the instrument is HUMAN SERVICES The six priorities are: ‘‘(1) Making publicly available. care safer by reducing harm caused by • When submitting topic areas, we Centers for Medicare & Medicaid the delivery of care; (2) ensuring that encourage including to the extent Services each person and family are engaged as available the following information: partners in their care; (3) promoting ++ Detailed descriptions of the [CMS–4171–NC] effective communication and suggested topic area(s) and specific coordination of care; (4) promoting the purpose(s). Medicare Program; Request for Information To Aid in the Design and most effective prevention and treatment ++ Relevant peer-reviewed journal practices for the leading causes of articles or full citations. Development of a Survey Regarding Patient Experiences With Hospital mortality, starting with cardiovascular • When submitting publicly available Outpatient Departments/ disease; (5) working with communities instruments or survey questions, we Ambulatory Surgery Centers and to promote wide use of best practices to encourage including to the extent Patient-Reported Outcomes From enable health living; and (6) making available the following information: and Procedures Performed quality care more affordable for ++ Name of the instrument. in These Settings individuals, families, employers and ++ Copies of the full instrument in all governments by developing and available languages. AGENCY: Centers for Medicare & spreading new health care delivery ++ Topic areas included in the Medicaid Services (CMS), HHS. models’’. instrument. ACTION: Request for information. Surveys focusing on the patient ++ Measures derived from the experience as well as the Hospital instrument. SUMMARY: This document is a request for Outpatient Surgery Department/ ++ Instrument reliability (internal information regarding hospital consistency, test-retest, etc) and outpatient surgery departments (HOSDs) 1 Please see U.S. Department of Health and validity (content, construct, criterion- and ambulatory surgery centers (ASCs), Human Services, Report to Congress, National Strategy for Quality Improvement in Health Care, related). as well as patient-reported outcomes (March 2011), available at http:// ++ Results of cognitive testing (one-on- from surgeries or other procedures www.healthcare.gov/law/resources/reports/ one testing with a small number of performed in these settings. nationalqualitystrategy032011.pdf.

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