Data Standardization: Looking Forward in Post-Acute Care

Stella Mandl, RNTechnical Advisor

Ellen M Berry, PTTechnical Director

Centers for Medicare & Medicaid ServicesBarbara Gage, PhD MPAFellow, Managing DirectorThe Brookings Institution

• Minimum Data Set (MDS)

• Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF PAI)

• Outcome and Assessment Information Set (OASIS)

• Long-term Care Hospital Continuity Assessment Record and Evaluation Data Set (LTCH CARE Data Set)

• Hospice Item Set (HIS)

Standardized Assessment Data Collection Vehicles

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• 2000: Benefits Improvement & Protection Act (BIPA) – mandated standardized assessment items across the

Medicare program, to supersede current items • 2005: Deficit Reduction Act (DRA)

– Mandated the use of standardized assessments across acute and post-acute settings

– Established Post-Acute Care Payment Reform Demonstration (PAC-PRD) which included a component testing the reliability of the standardized items when used in each Medicare setting

• 2006: Post-Acute Care Payment Reform Demonstration requirement:

– Data to meet federal HIT interoperability standards

CARE: Background

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Assessment Data is:• Standardized• Reusable • Informative

• Communicates in the same information across settings

• Ensures data transferability forward and backward allowing for interoperability

Standardization:• Reduces provider burden• Increases reliability and validity• Offers meaningful application to

providers• Facilitates patient centered care,

care coordination, improved outcomes, and efficiency

• Fosters seamless care transitions• Evaluates outcomes for patients that traverse

settings• Allows for measures to follow the patient• Assesses quality across settings, and Inform

payment modeling

CARE: Concepts

Guiding Principles and Goals:

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• Assessment Instrument/Data Sets: use of uniform and standardized items

• Measures harmonized at the Data Element level• Providers/vendors have public access to standards • Data Elements are easily available with national standards to

support PAC health information technology (IT) and care communication

• Transfer of Care Documents are able to incorporate uniform Data Elements used in PAC settings, if desired

• Measures can follow the person

Building the Future State

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• Facilities are able to transmit electronic and interoperable Documents and Data Elements

• Provides convergence in language/terminology

• Data Elements used are clinically relevant

• Care is coordinated using meaningful information that is spoken and understood by all

• Measures can evaluate quality across settings and evaluate intermittent and long term outcomes

• Measures follow the person

• Incorporates needs beyond healthcare system

Keeping in Mind, the Ideal State

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QIES ASSESSMENT DATA

QIES Chart

Q I E S

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A s s e s s m e n t

I n f r a s t r u c t u r eU s e r To o l s

D M S

Q I E S To S u c c e s s

jRAVEN

jHAVEN

jIRVEN

MDS OASISLTCH CARE

Assessment DB

N a ti o n a l R e p o r ti n g

S t a n d a r d A d H o c

CASPER QIES Work Bench

QIES National DB

A/B/HHH MAC Extract

ASAP

IRF-PAI

LASER

CDC

HART

HIS

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Assessment Data

• Assessment Software Development

• Assessment and Payment Initiatives

• Quality Initiatives

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Assessment Software Development

• Nursing Homes – MDS 3.0– Skilled nursing facilities (SNFs)– Nursing facilities (NFs)– Swing beds (SBs) – non-CAHs

• Home Health Agencies (HHAs) – OASIS-C• Inpatient Rehabilitation Facilities (IRFs) – IRF-PAI• Long Term Care Facilities (LTCHs) – LTCH CARE Data

Set• Hospice Providers

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Assessment Software Development

• Item Sets (MDS, SB)• Data specifications (all)• Error messages and reports (all)• Validation Utility Tool (all)• Payment groupers (MDS, OASIS, IRF-PAI)• Care planning, e.g., Care Assessment Areas (CAAs)• Public frequency reports (MDS)• QRP (LTCH, IRF, Hospice, HH)

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Assessment Software Development - General

• User Guide Manuals• Vendor calls• Help Desk• Tech email boxes

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Assessment & Payment Initiatives

• MDS– Section S – States– Additional items – States– Money Follows the Person– Survey & Certification– RUG-IV – Center for Medicare– RUG-III – States– A/B MAC extract

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Assessment & Payment Initiatives

• OASIS– Survey & Certification– HHRG– RHHI extract

• IRF– Rehab eligibility– CMG– IRF viewer– Claims validation

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Quality Initiatives

• Survey & Certification • Nursing Home Compare• 5-Star Program• Home Health Compare• HHA Pay for Reporting• HH Consumer Assessment of Healthcare

Providers and Systems (CAHPS)

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Quality Initiatives

• Quality Reporting Program – ACA 3004– Data submitted to CMS

• LTCH• IRF• Hospice

– Data submitted to CDC• LTCH• IRF

QIES Chart

Q I E S

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A s s e s s m e n t

I n f r a s t r u c t u r eU s e r To o l s

D M S

Q I E S To S u c c e s s

jRAVEN

jHAVEN

jIRVEN

MDS OASISLTCH CARE

Assessment DB

N a ti o n a l R e p o r ti n g

S t a n d a r d A d H o c

CASPER QIES Work Bench

QIES National DB

A/B/HHH MAC Extract

ASAP

IRF-PAI

LASER

CDC

HART

HIS

Data Flow Chart

MDS 3.0 DMS Options

Assessment Submission and

Processing (ASAP)Database

CMS StateDatabase

State Agency

Submission UploadedMessage

MDS Preview Reports

Validation Reports

NationalReportingDatabase

MDS 3.0 Data Flow12/27/2011

File Submission

Provider Reports

State Extract Files

Provider

State Extract Files

• Measures are strictly specified– Numerator– Denominator– Included / excluded populations

• Measures are endorsed by the National Quality Forum

• Publicly vetted• Data specifications identifying exact assessment

items are posted on web

PAC Quality Measures

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• Measure endorsement process– Concept is important to measure– Measure has scientifically reliable properties (wording

of atomic elements is such that 95 out of 100 assessors will get the same answer when coding a response)

– Feasibility – the data can be collected under current practice standards

– Usability and Use – the information is useful– Related and competing measures – not duplicative and

aligned with related measures

National Quality Forum Endorsement

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• Collect it once, use it multiple times– Assessment items (MDS, OASIS, IRFPAI) are factors

in the PPS rates for SNF, HHA, IRFs, respectively– Exact items are used to provide comparable data

across providers for rate setting and quality measurement purposes

Assessment Data in Payment/Quality Models

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