Data standardization looking forward in post acute care
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Data Standardization: Looking Forward in Post-Acute Care. Stella Mandl, RN Technical Advisor Ellen M Berry, PT Technical Director Centers for Medicare & Medicaid Services Barbara Gage, PhD MPA Fellow, Managing Director The Brookings Institution.

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Data standardization looking forward in post acute care

Data Standardization: Looking Forward in Post-Acute Care

Stella Mandl, RN

Technical Advisor

Ellen M Berry, PT

Technical Director

Centers for Medicare & Medicaid Services

Barbara Gage, PhD MPA

Fellow, Managing Director

The Brookings Institution


Standardized assessment data collection vehicles

Standardized Assessment Data Collection Vehicles

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)


Care background

CARE: Background

  • 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 concepts

CARE: Concepts

Guiding Principles and Goals:


Building the future state

Building the Future State

  • 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


Keeping in mind the ideal state

Keeping in Mind, the Ideal State

  • 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


Qies assessment data

QIES Assessment DATA


Qies chart

QIES Chart

QIES

Assessment

Infrastructure

User Tools

HART

QIES To Success

LASER

jHAVEN

National Reporting

A/B/HHH MAC Extract

jRAVEN

DMS

jIRVEN

Standard

Ad Hoc

IRF-PAI

OASIS

CASPER

QIES Work Bench

MDS

HIS

LTCH CARE

QIES National DB

ASAP

Assessment DB

CDC


Assessment data

Assessment Data

  • Assessment Software Development

  • Assessment and Payment Initiatives

  • Quality Initiatives


Assessment software development

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


Assessment software development1

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)


Assessment software development general

Assessment Software Development - General

  • User Guide Manuals

  • Vendor calls

  • Help Desk

  • Tech email boxes


Assessment payment initiatives

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


Assessment payment initiatives1

Assessment & Payment Initiatives

  • OASIS

    • Survey & Certification

    • HHRG

    • RHHI extract

  • IRF

    • Rehab eligibility

    • CMG

    • IRF viewer

    • Claims validation


Quality initiatives

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)


Quality initiatives1

Quality Initiatives

  • Quality Reporting Program – ACA 3004

    • Data submitted to CMS

      • LTCH

      • IRF

      • Hospice

    • Data submitted to CDC

      • LTCH

      • IRF


Qies chart1

QIES Chart

QIES

Assessment

Infrastructure

User Tools

HART

QIES To Success

LASER

jHAVEN

National Reporting

A/B/HHH MAC Extract

jRAVEN

DMS

jIRVEN

Standard

Ad Hoc

IRF-PAI

OASIS

CASPER

QIES Work Bench

MDS

HIS

LTCH CARE

QIES National DB

ASAP

Assessment DB

CDC


Data flow chart

Data Flow Chart


Pac quality measures

PAC Quality Measures

  • 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


National quality forum endorsement

National Quality Forum Endorsement

  • 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


Assessment data in payment quality models

Assessment Data in Payment/Quality Models

  • 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


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