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Written by: Darlene D'Altorio-Jones (1959-2015) on Wednesday, August 7, 2013 Posted in: Inpatient Rehab

Staying informed of the probability of what is to come in the Post Acute Care (PAC) service areas can be just as consuming as making sure that the present disparate reporting and payment programs are being followed for the various payment and tool models that drive reimbursement and data collection today.

The unknown can be stressful. So why keep information that is known today at greater than arms reach when you can read and learn about the project CMS funded to look at the possibility of melding post acute care reporting into one measurement tool? If the tool enabled more seamless tracking of a patient’s progression of health and independence in a way that allowed all venues of care to share the same information and to be certain that information gave longitudinal value as we pass the patient through a continuum of care, wouldn’t that be better? Would a tool like this truly enable improved transparency, and possibly reimbursement alignment that matched the resources consumed at each level so there were not huge discrepancies? Could we adopt and adapt to more efficient and effective care at just the right level with the exact patient needs? Are we ready?

Given the speed of change, you can’t be more ready than to think of the possibilities, read about the project discoveries and imagine how this information may affect us in the near future. Let’s stop avoiding the inevitable goals of improved outcomes, increased communication and very focused patient care needs.   Concepts that are certainly here to stay in a pay for performance, outcomes driven models of care with ever squeezed health care dollars. We should sneak a peak at the report and open our minds to the endless range of possibilities this information could drive given measurements across the post acute care continuum of services.

Let’s ask the question. Will the future of Post Acute Care (PAC) Evaluation and Outcomes be driven toward discussion and recommendations of the TEP (Technical Expert Panel) reviewing the data from the CARE (Continuity and Assessment Record and Evaluation) Project? This Item Set Report was provided to the Assistant Secretary for Planning and Evaluation (ASPE) published in November 2012.

If the information lends change of process to adopt functional status quality metrics to be used across the acute and postacute care (PAC) providers (including inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), skilled nursing facilities (SNFs), and home health agencies (HHAs)), just how long will it take to realign efforts to that homogenized model?

If you follow proposed regulations, I think you can see the writing on the wall. Some of these metrics are already aligning. Expectations and measurements will align through quality initiatives in the Measures Application Partnership (MAP) at the National Quality Forum. Proposed rulings are beginning to carry the marked recommendations. In an earlier blog I discussed how these measures were being proposed specifically within IRF environments.

As we drive for performance outcomes specific to functional measurement, one just has to look at the published CARE tool report to see very specifically the general level of performance of a key set of functions and just how different and alike the expectations might be in the overlap noted at admission and discharge for the same functional indicators over the 4 PAC settings.  Note that this scale is a 1-6 measurement and not a 1-7 scale. (See Appendix A, page 50 of the report).  Seeing this data, what types of questions might you ask if you were driving the post acute care evaluation process that enabled comparable measurement tools across the broad spectrum of care?