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Quality & Practice

Post Acute Care Quality Reporting

On September 18, 2014, Congress passed the Improving Medicare Post-Acute Care Transformation Act  of 2014 (the IMPACT Act).  The Act requires the submission of standardized data by Long-Term Care Hospitals (LTCHs), Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs) and Inpatient Rehabilitation Facilities (IRFs). 

IMPACT Act Implementation

There are 5 parts to IMPACT Act Implementation:

  • Incorporation of standardized assessment, including components of the CARE tool, into existing assessment tools across PAC providers.
  • Development and public reporting of quality measures across settings.
  • Hospitals and post acute care providers are required to provide quality measures to consumers when transitioning to a PAC provider (penalty of 2%).
  • The government is required to conduct studies and reports to link payment to quality.
  • $11M in funding for CMS to use payroll data to measure staffing in SNF setting.

Implications of Data Standardization

  • 1st round of CARE items implemented in PAC settings in 2016
  • Measures will be ADDED to existing measurement instruments used in post acute care settings:
    • Acute Hospitals > no standard tool, varies by hospital
    • Long-Term Care Hospitals > LTCH CARE
    • Inpatient Rehabilitation Facilities > IRFPAI
    • Skilled Nursing Facilities > MDS
    • Home Health Agencies > OASIS

IMPACT Act Timeline

PAC reporting

Reporting of Quality Measures

To the extent possible, the Secretary shall require reporting of such new quality measures through the PAC assessment instruments.

Timeline for New Quality Domains*

  • Functional Status
    • HHAs - 1/1/2019
    • SNFs - 10/1/2016
    • IRFs - 10/1/2016
    • LTCHs - 10/1/2018
  • Skin Integrity
    • HHAs - 1/1/2017
    • SNFs - 10/1/2016
    • IRFs - 10/1/2016
    • LTCHs - 10/1/2016
  • Medical Reconciliation
    • HHAs - 1/1/2017
    • SNFs - 10/1/2018
    • IRFs - 10/1/2018
    • LTCHs - 10/1/2018
  • Major Falls
    • HHAs - 1/1/2019
    • SNFs - 10/1/2016
    • IRFs - 10/1/2016
    • LTCHs - 10/1/2016
  • Patient Preference
    • HHAs - 1/1/2019
    • SNFs - 10/1/2018
    • IRFs - 10/1/2018
    • LTCHs - 10/1/2018
*Displayed dates are deadlines for measure specification and data collection. Confidential feedback reporting and public reporting is required one and two years, respectively, after the dates displayed above.

Requirement for Resource Use Measures

By October 1, 2016, the Secretary shall specify resource use and other measures for inclusion in the applicable reporting provisions. The resource use measures shall address, at a minimum, the following resource use domains: 1) Medicare spending per beneficiary; 2) discharge to community; 3) hospitalization rates of potentially preventable readmissions.

 

Academy Nominations for Measure Development Panels

The Academy has successfully nominated members to participate CMS measure development panels for the IMPACT Act measure development. Below is the current list of liaisons. While the Academy nominates the liaisons to participate on the measure development panels, these liaisons represent themselves as individuals with expertise on the panels, not the Academy.

  • Functional Status: Samuel Bierner, MD
  • Medication Reconciliation: KR Poduri, MD
  • Medicare Spending Per Beneficiary: Kurtis Hoppe, MD
  • Discharge to Community: Subhadra Nori, MD
  • Hospital Rates of Potentially Preventable Readmissions: Greg Worsowicz, MD

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