CMS Reveals Details of Home Health Standardized Assessments

In efforts to foster greater care coordination between various health care providers, the Centers for Medicare and Medicaid Services (CMS) revealed Wednesday new details on how it will measure the quality performance of home health care agencies through the collection of standardized data assessments.

During an Open Door Forum Wednesday afternoon, CMS outlined certain standardized assessments that post-acute care providers will be required to report in the coming years as mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 — or IMPACT Act — specifically for home health agencies, skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals.

The IMPACT Act was passed September 18, 2014 and signed into law by President Barack Obama on October 6, 2014. In general, it states CMS shall require the submission of standardized data by each of the aforementioned post-acute care providers to measure quality performance with respect to five domain categories specified by the law.

“The IMPACT Act allows for information to follow the person,” said Stella Mandl, RN, deputy director for CMS’s Division of Chronic and Post-Acute Care, a branch of the agency’s Center for Clinical Standards and Quality. “The use of standardized data enables another chapter in post-acute care, where providers would be able to utilize data for care coordination purposes.”

Home health agencies will have to begin reporting standardized assessment data no later than January 1, 2019, whereas skilled nursing facilities, inpatient rehab facilities and long-term care hospitals will be required to do so no later than October 1, 2018.

Although the implementation dates are still a few years away, the purpose of the CMS forum this week was to provide organizations a glimpse of what to expect as the federal agency continues to develop specific processes for the data reporting.

Post-acute care providers will be required to report standardized data across what CMS calls five quality measure domains.

These include reporting assessments as they apply to patients’ functional status, cognitive function and changes in these functions; skin integrity and changes in skin integrity; medication reconciliation; incidence of major falls; and communicating the existence of and providing for the transfer of health information and care preferences.

In addition to these measures, data for reporting may also include claims data as well as other measure domains including: an organizations’ total estimated Medicare spending per beneficiary; discharge to community; and measures to reflect all-condition risk-adjusted preventable hospital readmission rates.

“These measures tie directly to the goals and objectives of CMS’s quality strategy,” Mandl said.

In collecting standardized data, CMS plans to use what it calls the Continuity Assessment Record and Evaluation (CARE) Item Set, a tool developed for use at acute hospital discharge and post-acute care admission and discharge as part of the Medicare Post-Acute Care Payment Reform Demonstration (PAC-PRD).

The CARE Item Set is designed to standardize, across providers, the assessment of patients’ medical, functional, cognitive and social support status. The tool targets a range of measures that document variations in a patient’s level of care needs, including factors related to treatment and staffing patterns.

But while CMS is currently working to further develop procedures for collecting the data, it assured that the data collection process will go through the current OASIS system for home health agencies. For other post-acute care providers, collection will occur through their respective data tools.

“Approaching the IMPACT Act is a marathon, not a sprint,” Mandl said. “It’s an opportunity to bring what may have been many seams into a seamless health care environment.”

Written by Jason Oliva

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