Bill introduced in House and Senate to further quality reporting in post-acute care

Leaders from the Senate Finance Committee and House Ways and Means Committee have introduced the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), which would set quality standards and mandatory reporting deadlines for post-acute care provided by long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home health agencies.

Notably, the Act would not require inpatient prospective payment system hospitals or critical access and cancer hospitals to report patient assessment data, a change lobbied for by the American Hospital Association.

In the Senate, the bill was introduced by Finance Committee Chairman Ron Wyden (D-Ore.) and Ranking Member Orrin Hatch (R-Utah). The companion bill in the House was introduced by Ways and Means Chairman Dave Camp (R-Mich.) and Ranking Member Sandy Levin (D-Mich.).

According to a press release issued by the House Ways and Means Committee, the main goal of the IMPACT Act is to require data standardization to enable Medicare to:

1. Compare quality across different post-acute care settings;
2. Improve hospital and post-acute care discharge planning; and,
3. Use this information to reform post-acute care payments (via site neutral or bundled payments or some other reform) while ensuring continued beneficiary access to the most appropriate setting of care.

The bill’s quality measures include functional status, skin integrity, medication reconciliation, major falls and patient preference. Skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals would begin reporting some of these measures in October of 2016, with confidential feedback sent the following year and public reporting of the measures occurring in 2018.

The secretary of the Department of Health and Human Services would also create measures of resource use, such as per Medicare beneficiary spending and hospital re-admission rates. In addition, if signed into law, the Act would allow the secretary to create additional resource and quality measures in the future without Congressional action. There would be payment consequences for providers who choose not to report standardized data.

The AHA noted that the bill includes several of its recommendations on risk adjustment, removal of redundant reporting requirements, and confirmation that the legislation will not affect current post-acute payment systems. This includes risk adjustment by patient socio-economic status, something the hospital re-admission reduction program did not have and which is now causing problems for hospitals that treat a high percentage of poor patients.

In addition, the bill would require changes to the Conditions of Participation for post-acute care providers, inpatient PPS, cancer, and critical assess hospitals so that PAC quality measure data are used to inform the discharge planning process.

A better approach to measuring quality in post-acute care and figuring out which patients belong in which care settings is long overdue say the legislators behind the bill and some members of the field, as highlighted by a recent New York Times article.

“We don’t know how to measure quality,” said Jeremy Kahn, M.D., M.S., associate professor of critical care, medicine and health policy in the University of Pittsburgh School of Medicine, in the New York Times article. “The current Medicare quality measures are borrowed from I.C.U.s. Whether they apply in long-term acute care hospitals is unknown.”