acute ip, op, irf, snf, pp - health care software solutions€¦ · impact act + begins the...
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About Mediware
+ Rehabilitation
Acute IP, OP, IRF, SNF, PP
+ Respiratory
+ 250+ Rehab Facilities
+ Chandler, Arizona
+ CORE Focus
(Compliance, Outcomes, Revenue, Efficiency)
ONC Certified
Prepare for IMPACT
Presented by:
Bob Habasevich, MS, PT., V.P., Provider Quality and Performance Improvement,
Darlene D’Altorio-Jones, PT., MBA-HCM, Senior Consultant, Strategist
November 20, 2014
About Mediware
+ Rehabilitation and Respiratory Care Division+ 25+ years in business
+ Specialists – Knowledge & Experience+ Acute, IRF, SNF, LTAC, Home+ Outpatient Rehab+ Respiratory
+ Solution – MediLinks+ Compliance+ Outcomes+ Revenue + Efficiency
+ ONC Meaningful Use – Stage 2+ ICD-10 Prepared Chandler, AZ headquarters
MediLinks for IRF, OP and Acute
+ Documentation and Workflow Specific To IRF , OP, Acute requirements
+ Improve compliance, patient and financial outcomes and efficiency
+ Pre-Admission / Post-Admission / Therapy Evaluations – Real-time reporting (IRF)
+ Billing is a by-product of Documentation – Increase Charge Capture & Revenue
+ FIM Scoring Integrity – Results = Improved Revenue Accuracy (IRF,)
+ IRFPAI Integration – Automated to select appropriate FIM scores (IRF)
+ 3 Hour Rule compliance – Monitor 3/5 or 15/7 real-time (IRF)
+ Interdisciplinary Plan of Care – Common view/document to meet CMS regulations
+ Goals Management – Short/Long Term goals - patients barriers to discharge
+ Task list - Data driven watch-dog custom for each user
+ Schedule multiple procedures with various resources (IRF. OP)
+ Appointment reminders – reduce no-shows and cancellations (OP)
Complementing Hospital Information Systems
Pre-built HL7 Interfaces • ADT In
• Orders In/Out
• Results In/Out
• Billing Out
• Narrative In/Out
• Scheduling In/Out
Experience with all HIS
Improved Workflow
MEDITECH
Prepare for IMPACT
Presented by:
Bob Habasevich, MS, PT., V.P., Provider Quality and Performance Improvement,
Darlene D’Altorio-Jones, PT., MBA-HCM, Senior Consultant, Strategist
November 20, 2014
Discussion / Agenda
+ The date the Impact Act was signed into law
+ What settings in PAC are affected through this legislation?
+ CMS rationale in the need for alignment/change
+ What are the main ‘features’ of the Impact Act?
+ What are the timelines for achieving these main features?
+ What is expected now and going forward to reach the alignment and reporting mandates set forth in the Act?
The IMPACT Act of 2014 (H.R. 4994/S. 2553)
+ Improving Medicare Post-Acute Care Transformation (IMPACT)
-President Obama signed into Law on October 6, 2014
+ The Act mandates that post-acutesettings begin reporting of qualitymeasures starting on October 1, 2016, and
+ Standardized patient assessment data by October 1, 2018.
+ This information is necessary to the development of Medicare PAC payment reform.
+ This legislation will have a significant impact on expediting CMS’ use of data to compare quality, cost and other factors across settings.
Why Was This Necessary?
+ Post-acute care is fragmented, poorly coordinated and only now becoming a factor for effective population healthcare management.
+
Hospital Skilled Nursing/
Rehabilitation Home Health Hospice
Why Was This Necessary?
Why Was This Necessary?
+ Wide variation in cost and care for patients requiring post-acute care
SOURCE: Committee analysis of unpublished Dartmouth data.*Variation in Health Care Spending, Target Decision Making, Not Geography (2013). MedPAC and IOM
How We Got Here
Source: Lisa Grabert, House Ways & Means, Barbara Gage and Kelsey Mellard, PACCRNovember 4, 2014. paccr.org
2011:President’s Budget Introduces
Bundling
How Will the Act Reduce Cost and Improve Care?
Strategies to Integrate Care across PAC Settings
Source:
One Third of Hospital Discharges go to PAC
Source: Cain Brothers, INTEGRATING ACUTE AND POST-ACUTE CARE:THE EMERGING MERGING OF THE SECTORS, 2012
IMPACT the Readmission Boomerang
Source: Cain Brothers, RTI, INTEGRATING ACUTE AND POST-ACUTE CARE:THE EMERGING MERGING OF THE SECTORS, 2012
Changes Underway
Affordable Care Act. Public Law 111-148 and Public Law 111-152
Source:
IMPACT Act
+ Begins the standardizing of post-acute care assessment data for quality, payment, and discharge planning, and for other purposes.
+ All PAC providers; HH, SNF, IRF and LTCH’s included.
+ Standardized collection on functional status, cognitive function, medical needs and conditions, impairments and other categories deemed necessary by Secretary.
+ Some data are already submitted by each PAC provider, but varies by type of provider, Act calls for replacing duplicative data collection.
+ Resource use data also collected to estimate per beneficiary spend.
+ Includes payment refinement provisions via report from MedPAC to Congress in 2016 based on PAC PRD data and report from CMS
+ Hospice mandated reviews.
IMPACT Act – Guiding Change
+ Not intended to dictate WHERE patients should be treated and or the specific ‘venue’ of service.
+ 6/30/2017 – MedPac report outlining ‘technical prototype’ and how standardized assessment will work.
+ Standardized Assessment Data collection begins 10/1/2018.
+ Again, payment system driven by characteristics such as function, cognition, impairment, health status of the individual RATHER than the venue of care.
+ The IMPACT Act requires standard assessment data be collected using modified standard assessments for each venue.
Quality Measures
+ The CMS Center for Clinical Standards and Quality will develop quality metrics that can measure patient’s medical, functional, and cognitive status
Timeline for New Quality Domains
Quality Domains HHAs SNFs IRFs LTACHs
Functional Status 1/1/2019 10/1/2016 10/1/2016 10/1/2018
Skin Integrity 1/1/2017 10/1/2016 10/1/2016 10/1/2016
Medication Reconciliation 1/1/2017 10/1/2018 10/1/2018 10/1/2016
Major Falls 1/1/2019 10/1/2016 10/1/2016 10/1/2016
Patient Preferences 1/1/2019 10/1/2018 10/1/2018 10/1/2018
Standard Assessment
+ Providers will report standardized patient assessment data across post-acute settings by; October 1, 2018 for SNFs, IRFs and LTCHs and
January 1, 2019 for HHAs.
+ The data shall include functional status, cognitive function and mental status, special services, medical condition, impairments, prior functioning levels and other categories as determined by the Secretary of HHS.
Resource Measures
+ By October 1, 2018 for SNF, IRF and LTCH and January 1, 2019 for HHA, the Secretary shall create procedures for making available to the public information pertaining to individual PAC performance related to the resource use measures.
Patient Preferences and Discharge Planning
+ The HHS Secretary is required to develop a process around using quality and resource use measures to assist providers, suppliers, beneficiaries and the families with discharge planning from inpatient or PAC settings.
+ The guidance shall include procedures to address patient treatment preferences and goals of care.
Redefined Payment
+ The CMS Center for Medicare will develop ( 1/1/2021)
standardized payment methods for:
+ Chronically Critically Ill populations
+ Skilled Nursing Facility populations
+ Inpatient Rehabilitation Facility populations
+ Home Health populations
Timelines
Time Lines
Timelines
Implications- Short Term
+ Standardizing Data elements does not mean a standardized assessment instrument; we can expect that existing standard instruments will be modified to accommodate data standards.
+ Standard measurement of function will be defined (somehow) between now and October 2016.
+ Patient preference for treatment and discharge will require standard reporting methodology across PAC providers, also to be determined between now and October 2016.
+ Care provided in different settings should not be expected to be the same, but differing by patient severity/need and provider ability to deliver by defined resource intensity criteria.
+ So too, payment will be modified based upon patient requirements, provider resources and care effectiveness demonstration.
What Can You do Now?
What Can You do Now?
+ Adopt systems to Standardize Measurement and Documentation and reporting requirement;
+ Identify cost of care variables, quantify and record;
+ Anticipate the requirement to report patient specific resource costs, begin integrating into clinical decisions;
+ Engage in cross continuum dialogue with other PAC providers to understand care similarities and differences; and
+ Establish transfer communication and coordination methods with tracking and accountability reporting.
Questions?
IMPACT Act 2014: https://www.govtrack.us/congress/bills/113/hr4994/text
For more information visit:
Mediware.com
(888) MEDIWARE
(633-4927)