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CARE Tool Revisited

Written by: Mediware on Friday, March 21, 2014 Posted in: Inpatient Rehab

The thought of a common assessment instrument for post-acute care has been an active policy and regulatory pursuit for lawmakers and payors for almost a decade. To establish common measures across all post-acute provider types requires standard measurement and reporting of patient status and delivery elements. In 2005 the Medicare Payment Advisory Commission (MedPAC) recognized the need for a common assessment and congress enacted the Deficit Reduction Act of 2008. It directed CMS to develop and test the Continuity Assessment Record and Evaluation (CARE) Tool for the purpose of identifying common data elements across post-acute providers.   

This week the House Ways and Means Committee drafted the Improving Medicare Post-Acute Care Transformation Act of 2014, ( proposing the first data standards for post-acute care. While only draft legislation, it builds upon all previous work done by CMS to define a common assessment instrument and its data elements. This work put forth the data requirements needed to make comparisons of quality and outcomes of care regardless of which post-acute venue delivered it. The proposed legislation takes the initiative to impose these data requirements into the existing assessments for each post-acute provider; 1) Outcome and Assessment Information Set (OASIS); 2) the Minimum Data Set (MDS); 3) the IRF-Patient Assessment Instrument (IRF-PAI); and 4) LTCH-Continuity Assessment and Record Evaluation (LTCH-CARE). 

These data will report Quality and Resource Use Measures, each being phased in during the next years. The Secretary of HHS is given authority to add, omit or change reporting requirements as deemed appropriate without congressional approval:

“Requirement for New Quality Measures. By October 1, 2016 for SNF, IRF and LTCH and January 1, 2017 for HHA, the Secretary shall specify additional quality measures that PAC providers are required to submit under the applicable reporting provisions. The measures shall address, at a minimum, the following quality domains: 1) functional status and changes in function; 2) skin integrity and changes in skin integrity; 3) medication reconciliation; 4) incidence of major falls; and 5) patient preference regarding treatment and discharge options.

“Requirement for Resource Use Measures. By October 1, 2016, the Secretary shall specify resource use and other measures for inclusion in the applicable reporting provisions. The resource use measures shall address, at a minimum, the following resource use domains: 1) efficiency measures to include total Medicare spending per beneficiary; 2) discharge to community; and 3) risk adjusted hospitalization rates of potentially preventable admissions and readmissions.”

The House Ways and Means Committee in their summary proposed the roll out timeline for required actions.


In addition, this legislation would extend the reporting standards to include outpatient therapy Medicare Part B providers. It will be very interesting to watch the debate to determine which functional measure(s) will become the standard for reporting.

My colleague and I were eager to blog about this news, so you can ready more about the IMPACT Act in her blog.

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