1 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Improving Medicare Post-Acute Care...

1UCLA Borun CenterFOR GERONTOLOGICAL RESEARCHHEALTH

Improving Medicare Post-AcuteCare Transformation Act of 2014

IMPACT Act

Centers for Medicare &

Medicaid Services

Special Open Door Forum on the

Improving Medicare Post-AcuteCare Transformation Act of 2014

IMPACT Act

October 27, 2015

2:00pm-3:30pm 1


Welcome

Centers for Medicare & Medicaid Services along with its contractor, RAND Corporation

Welcomes You

Goals of this Call: Overview of the Improving Medicare Post-Acute Care

Transformation Act of 2014(IMPACT Act) for standardized assessment in the post-acute care (PAC) setting.

Interactive conversation2


Overview

Introduction to RAND team

Why Universal Assessment?

Discussion & Listening session

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UCLA Borun CenterFOR GERONTOLOGICAL RESEARCHHEALTH

RAND & UCLA Borun Center Debra Saliba, MD, MPH, AGSF Maria Edelen, PhD Liisa Hiatt, MS Mark Hanson, PhD

PACCR Barbara Gage, PhD

Team Leaders

ABT Alan White, PhD Allison Muma, MHA

ATLAS Jason Ormsby, PhD, MBA,

MHSA

Qualidigm Ann Spenard, MSN, RN-BC

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Improving Medicare Post-AcuteCare Transformation Act of 2014 IMPACT

“Using common standards and definitions, in order to provide access to longitudinal information … to facilitate coordinated care and improved Medicare beneficiary outcomes”

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Why Post Acute Care?

42% of Medicare fee for service beneficiaries discharged from hospitals go to PAC

Sicker and quicker discharges

Large numbers of Medicare enrollees served in these settings (over 5.5 million beneficiaries)

Recovery, support and rehabilitation Transition to lowest safe level of care

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Important Part of the Health Care System


What Assessments do we have now?

4 different settings, 4 different assessments

Skilled nursing Facilities (SNF) Minimum Data Set

Home Health Agencies (HHA) OASIS

Inpatient Rehabilitation Facilities (IRF) IRF-PAI

Long Term Care Hospitals (LTCH) LTCH CARE Data Set

Assessments lack common standards & definitions 7


IMPACT Act Identifies Categories that Require the Use of Standardized Data

Function (e.g., self care and mobility) Cognitive Function (e.g., express & understand ideas;

mental status, such as depression and dementia) Special services, treatments & interventions (e.g.,

need for ventilator, dialysis, chemotherapy, and total parenteral nutrition)

Medical conditions and co-morbidities (e.g., diabetes, heart failure, and pressure ulcers)

Impairments (e.g., incontinence; impaired ability to hear, see, or swallow)

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IMPACT Act Identifies Domains for Quality Measures that Use Standardize Assessment Data

Quality measures on which PAC providers must submit standardized patient assessment data Functional status, cognitive function, and changes in

function and cognitive function. Skin integrity and changes in skin integrity. Medication reconciliation. Incidence of major falls. Communicating and providing for the transfer of health

information and care preferences of an individual when the individual transitions.

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Why Uniform Assessment Items? Potential to Improve Care & Coordination

Facilitate consistent and reliable identification of the individual’s met and unmet needs

Use of common assessment language can decrease fragmentation

Support care transitions

Simplify access to programs and supports Improve information on quality and health outcomes

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Why Uniform Assessment Items? Potential to Improve Program Planning and Evaluation

Enhance information exchange and data sharing

Allow better understanding of the population receiving post-acute care Particularly important as programs

evolve Better monitor quality and health

outcomes11


Uniform Assessment Items: Potential Challenges

Change can be costly and requires significant planning

Served populations are diverse

Uniform items ≠ accurate and useable

Perfect can be enemy of good Tradeoff between Comprehensive and Feasible

Item set constituencies: developers and programs

Protecting individual voice

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CMS Progress to Date

Functional Status Items IRF, SNF and LTCH

Pressure Ulcers Falls

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Guiding Principles for Our Approach

Promote Better Care Make care safer and more reliable Effective communication & care coordination Track outcomes

Person centered processes and items Support care planning focused on optimizing independence &

preferences Engage persons and families in design

Improve the value of care Each care setting will continue to have items selected to

special relevance to that setting

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What do we mean by Person-centered?

Refers to an approach that reflects the individual’s Goals, Strengths, Needs & Preferences

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Design Stage 1: Iterative Process to Identify Candidate Items

•Stakeholder ODF

•Identify “best in class”

•Case studies

•Stakeholder feedback

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Design Stage 2: Field Study

Test item performance in all 4 settings Clarity Reproducibility (reliability) Burden and acceptability

Providers Consumers

Focus Groups and TEPs to review Results

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Design Stage 3: Identify and Address Gaps

Work with stakeholders to identify gaps

Identify and define additional items

Field test additional items

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Design Stage 4: Implementation

Finalize instructions and items in consultation with stakeholders

Training of providers

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Why Are We Having This Open Door Forum?

Integrate the knowledge, experiences, and insights of diverse stakeholders into our approach, selection and testing of assessment items for the domains

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What Do We Hope To Accomplish Today?

1. Gain insight into how consumers and families view uniform, standardized assessment

2. Obtain a wide range of perspectives

3. Learn about concerns and preferences of consumers and families

4. Ensure that Standardized Assessment supports person-centered principles and protections

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Create better assessments, responsive to consumer needs


Some Questions to Get us Started

How can assessment support safer care? How can assessments better support the engagement

of each person and family? What type of information do you want to see

transferred across setting or available at return home? What goals and preferences should be obtained and

transferred? What concerns do you have about standardized

assessment? How can consumers get involved in these efforts?

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Summary

Goal is to develop person-centered standardized assessment items for PAC

Background and priority work has occurred We need to hear a wide-range of voices Stakeholders will be engaged throughout the

process Thanks for working with us Much more work to do

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1 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Improving Medicare Post-Acute Care...

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