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Claims-based quality measure of visit intensity near death
A claims-based HQRP quality measure reporting the share of patients who received in-person RN or medical social worker visits on at least two of the final three days of life.
The Hospice Visits in the Last Days of Life (HVLDL) measure is a claims-based HQRP quality measure reporting the proportion of a hospice's patients who received in-person visits from a registered nurse or medical social worker on at least two of the final three days of life (HVLDL measure specifications)[1]. It is calculated from Medicare claims, so hospices do not submit anything specific for it.
The measure defines the last three days of life as the day of death, the day before death, and two days before death (HVLDL measure specifications)[1]. The numerator counts patients who received qualifying visits on at least two of those three days from an RN or a medical social worker; the visits must be in person on different days, and telephonic contact does not count. The denominator includes patients who received hospice services for at least three days, so very short stays are excluded. HVLDL is one of two HQRP measures derived entirely from Medicare claims, the other being the Hospice Care Index (Current Measures)[2]. It is publicly reported on Care Compare, and a hospice's score is suppressed if it has fewer than 20 qualifying denominator cases (HQRP Quality Measure Specifications User's Manual)[3]. HVLDL is a claims-based quality measure and is distinct from the CAHPS-based star rating, which is calculated only from survey data. The end-of-life visit pattern HVLDL captures overlaps with the care that generates the Service Intensity Add-on (SIA), the add-on payment for RN and social worker visits near the end of life.
HVLDL is unusual among reported measures because it cannot be adjusted at the reporting stage; it reflects what staffing actually did in the last days of life, pulled straight from claims. A low score is a visible, public signal on Care Compare of end-of-life staffing intensity. The reimbursement and quality signals align: the RN and medical social worker visits that move HVLDL are largely the same visits that generate the Service Intensity Add-on, so stronger end-of-life visit patterns improve a public quality measure and capture additional payment at the same time. Smaller programs with fewer than 20 qualifying denominator cases will have their score suppressed, which means they do not appear publicly on this measure.
The proportion of patients who received in-person visits from an RN or medical social worker on at least two of their final three days of life (HVLDL measure specifications)[1].
No; only in-person visits by a registered nurse or medical social worker on different days count toward the numerator (HVLDL measure specifications)[1].
No; it is calculated from Medicare claims, so there is no separate assessment to submit (Current Measures)[2].
The RN and medical social worker visits that count toward the HVLDL numerator — in-person visits on the last three days of life — are substantially the same visits that generate the Service Intensity Add-on payment. A hospice with a higher HVLDL score is, in most cases, also capturing more SIA revenue, because both metrics are driven by visit intensity from the same qualifying clinicians in the same time window (HVLDL measure specifications, https://www.cms.gov/files/document/hospice-visits-last-days-life-hvldl-measure-specifications.pdf; CMS MM14190, https://www.cms.gov/files/document/mm14190-hospice-payments-fy-2026-update.pdf).
Vitalis Care is the end-of-life care app that helps hospices deliver compassionate care — while staying on top of schedules, field operations, documentation, compliance, and reimbursement.
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