1 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Improving Medicare Post-Acute Care Transformation Act of 2014 IMPACT Act Centers for Medicare & Medicaid Services Special Open Door Forum on the Improving Medicare Post-Acute Care Transformation Act of 2014 IMPACT Act October 27, :00pm-3:30pm 1

2 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Welcome  Centers for Medicare & Medicaid Services along with its contractor, RAND Corporation Welcomes You  Goals of this Call:  Overview of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) for standardized assessment in the post-acute care (PAC) setting.  Interactive conversation 2

3 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Overview  Introduction to RAND team  Why Universal Assessment?  Discussion & Listening session 3

UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH RAND & UCLA Borun Center  Debra Saliba, MD, MPH, AGSF  Maria Edelen, PhD  Liisa Hiatt, MS  Mark Hanson, PhD PACCR  Barbara Gage, PhD Team Leaders ABT  Alan White, PhD  Allison Muma, MHA ATLAS  Jason Ormsby, PhD, MBA, MHSA Qualidigm  Ann Spenard, MSN, RN-BC 4

5 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Improving Medicare Post-Acute Care Transformation Act of 2014  IMPACT  “Using common standards and definitions, in order to provide access to longitudinal information … to facilitate coordinated care and improved Medicare beneficiary outcomes” 5

6 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Why Post Acute Care?  42% of Medicare fee for service beneficiaries discharged from hospitals go to PAC  Sicker and quicker discharges  Large numbers of Medicare enrollees served in these settings (over 5.5 million beneficiaries)  Recovery, support and rehabilitation  Transition to lowest safe level of care 6 Important Part of the Health Care System

7 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH What Assessments do we have now?  4 different settings, 4 different assessments  Skilled nursing Facilities (SNF)  Minimum Data Set  Home Health Agencies (HHA)  OASIS  Inpatient Rehabilitation Facilities (IRF)  IRF-PAI  Long Term Care Hospitals (LTCH)  LTCH CARE Data Set  Assessments lack common standards & definitions 7

8 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH IMPACT Act Identifies Categories that Require the Use of Standardized Data  Function (e.g., self care and mobility)  Cognitive Function (e.g., express & understand ideas; mental status, such as depression and dementia)  Special services, treatments & interventions (e.g., need for ventilator, dialysis, chemotherapy, and total parenteral nutrition)  Medical conditions and co-morbidities (e.g., diabetes, heart failure, and pressure ulcers)  Impairments (e.g., incontinence; impaired ability to hear, see, or swallow) 8

9 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH IMPACT Act Identifies Domains for Quality Measures that Use Standardize Assessment Data Quality measures on which PAC providers must submit standardized patient assessment data  Functional status, cognitive function, and changes in function and cognitive function.  Skin integrity and changes in skin integrity.  Medication reconciliation.  Incidence of major falls.  Communicating and providing for the transfer of health information and care preferences of an individual when the individual transitions. 9

10 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Why Uniform Assessment Items? Potential to Improve Care & Coordination  Facilitate consistent and reliable identification of the individual’s met and unmet needs  Use of common assessment language can decrease fragmentation  Support care transitions  Simplify access to programs and supports  Improve information on quality and health outcomes 10

11 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Why Uniform Assessment Items? Potential to Improve Program Planning and Evaluation  Enhance information exchange and data sharing  Allow better understanding of the population receiving post-acute care  Particularly important as programs evolve  Better monitor quality and health outcomes 11

12 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Uniform Assessment Items: Potential Challenges  Change can be costly and requires significant planning  Served populations are diverse  Uniform items ≠ accurate and useable  Perfect can be enemy of good  Tradeoff between Comprehensive and Feasible  Item set constituencies: developers and programs  Protecting individual voice 12

13 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH CMS Progress to Date  Functional Status Items  IRF, SNF and LTCH  Pressure Ulcers  Falls 13

14 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Guiding Principles for Our Approach  Promote Better Care  Make care safer and more reliable  Effective communication & care coordination  Track outcomes  Person centered processes and items  Support care planning focused on optimizing independence & preferences  Engage persons and families in design  Improve the value of care  Each care setting will continue to have items selected to special relevance to that setting 14

15 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH What do we mean by Person-centered?  Refers to an approach that reflects the individual’s  Goals,  Strengths,  Needs &  Preferences 15

16 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Design Stage 1: Iterative Process to Identify Candidate Items Stakeholder ODF Identify “best in class” Case studiesStakeholder feedback 16

17 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Design Stage 2: Field Study  Test item performance in all 4 settings  Clarity  Reproducibility (reliability)  Burden and acceptability  Providers  Consumers  Focus Groups and TEPs to review Results 17

18 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Design Stage 3: Identify and Address Gaps  Work with stakeholders to identify gaps  Identify and define additional items  Field test additional items 18

19 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Design Stage 4: Implementation  Finalize instructions and items  in consultation with stakeholders  Training of providers 19

20 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Why Are We Having This Open Door Forum? Integrate the knowledge, experiences, and insights of diverse stakeholders into our approach, selection and testing of assessment items for the domains 20

21 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH What Do We Hope To Accomplish Today? 1.Gain insight into how consumers and families view uniform, standardized assessment 2.Obtain a wide range of perspectives 3.Learn about concerns and preferences of consumers and families 4.Ensure that Standardized Assessment supports person-centered principles and protections 21 Create better assessments, responsive to consumer needs

22 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Some Questions to Get us Started  How can assessment support safer care?  How can assessments better support the engagement of each person and family?  What type of information do you want to see transferred across setting or available at return home?  What goals and preferences should be obtained and transferred?  What concerns do you have about standardized assessment?  How can consumers get involved in these efforts? 22

23 UCLA Borun Center FOR GERONTOLOGICAL RESEARCH HEALTH Summary  Goal is to develop person-centered standardized assessment items for PAC  Background and priority work has occurred  We need to hear a wide-range of voices  Stakeholders will be engaged throughout the process  Thanks for working with us  Much more work to do 23