CMS Hospice Care Index Live Discharge Quality Measurement: Insights from Non-Profit Hospice Leaders.

Abstract

Hospice live discharge affects approximately 20% of enrollees and often disrupts supportive care, increasing patient and family burden. The CMS Hospice Care Index (HCI) assesses hospice quality, including four live discharge-focused measures: early (<7 days), late (>180 days), Type 1 burdensome transition (discharge-hospital-readmission) and Type 2 (discharge-hospital-death). Little is known about the utility and implications of the HCI live discharge measures on clinical care and policy since their implementation. This study analyzed responses from semi-structured interviews of hospice leaders (N=20) from seven non-profit hospices, collected November 2024-July 2025. Analysis was conducted using a four-step rapid approach, suitable for exploratory interviews. Participants viewed the HCI live discharge measures as important quality indicators for promoting accountability and improving staff training and communication to prevent inappropriate discharges. However, they expressed concerns surrounding: 1) accurate indication of care quality, 2) implications for hospice admissions and discharge practices to avoid enrolling high-risk patients, and 3) financial impacts of non-reimbursed discharge-focused care. The HCI live discharge measures are important for monitoring care quality but may have unintended clinical and operational consequences. Future research should refine quality measurement and consider the role of reimbursement incentives to promote care continuity and support comprehensive discharge planning to mitigate adverse outcomes.