Measuring Post-Acute Care in LTCHs, IRFs, SNFs and HHAs

Huh? What's up with all the acronyms?

Great question and truthfully besides taking up less space in the blog's headline, the acronyms listed are settings for post-acute care (i.e. post-hospital care) and (not surprisingly) each has its own quality and outcome measurements as well as reimbursement systems. (Check the blog's glossary for more information about the acronyms posted in the headline.)

A few months ago, while visiting a relative in an area hospital, I overheard a conversation themed around the complexity of deciding which post-acute care (PAC) option is the best option. Interestingly, this decision is not only complex for a patient's family, it is also difficult for CMS (the federal agency which administers Medicare and Medicaid) to make that very same determination. This is not a recent problem, by 2002 when one-third Medicare beneficiaries discharged from hospitals utilized some form of PAC within one-day of leaving the hospital, it was obvious that patient's medical, functional and cognitive statuses were not collected in a consistent manner across all PAC settings. The federal government suspected this resulted in inconsistent reimbursement to providers as well as patient outcomes.

In 2005, CMS commissioned a report to investigate what data elements could be used to allow for common payments and outcome measurements across PAC settings. The resulting report, published in 2006 (here) issued a long-term vision and short term steps for creating uniform PAC assessment tool and identified core measures of a patient's medical, functional and cognitive statuses.

By November 2008, over 140 providers representing acute and PAC settings from around the country were collecting data using the newly developed Continuity Assessment Record and Evaluation (CARE) tool. Last month, CMS delivered the report to Congress on the tool named the Continuity Assessment Record and Evaluation (CARE) tool. The report suggests that the potential for development of a common payment system for routine services and therapy services in the three inpatient PAC settings: LTCHs, IRFs and SNFs. The report also suggests that home health routine services and therapy services be modeled separately from the inpatient PAC settings.

The findings regarding comparisons in patient outcomes between the settings are highly nuanced. The language suggests that further exploration is needed to determine causality of findings.

The report concluded that the implementatonof CARE was successful. All five setting were able to use CARE to collect information in a consistent, reliable manner. CMS believes that it should pursue development efforts towards integrating CARE into the reporting requirements for acute care hospitals, SNFs, HHAs, IRFs and LTCHs.

What this means:

For providers, it will eventually mean adapting to a new assessment tool and its corresponding reimbursement system. For the federal government, it will (hopefully) allow for greater understanding of which care setting offers superior outcomes and at what cost.

What are your thoughts?

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    Bruce Lederman has over 25 years experience in the senior care field as a direct care provider and thought leader. Bruce was CEO and president of his own firm that operated skilled nursing facilities in Illinois. He is a former nursing home administrator and has consulted to numerous elder care providers on planning for strategic growth as well as process improvement. Recently he served as board chair of CJE SeniorLife, a leading non-profit elder care provider in the Chicago area. Bruce is currently employed as chief strategy officer for a company providing skilled nursing services in communities throughout Illinois and Missouri.

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