Data Standardization: Looking Forward in Post-Acute Care

1. Data Standardization: Looking Forward in Post-Acute Care Stella Mandl, RN Technical Advisor Ellen M Berry, PT Technical Director Centers for Medicare & Medicaid Services Barbara Gage, PhD MPA Fellow, Managing Director The Brookings Institution

2. Standardized Assessment Data Collection Vehicles Minimum Data Set (MDS) Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF PAI) Outcome and Assessment Information Set (OASIS) Long-term Care Hospital Continuity Assessment Record and Evaluation Data Set (LTCH CARE Data Set) Hospice Item Set (HIS)

3. CARE: Background • 2000: Benefits Improvement & Protection Act (BIPA) • mandated standardized assessment items across the Medicare program, to supersede current items • 2005: Deficit Reduction Act (DRA) • Mandated the use of standardized assessments across acute and post-acute settings • Established Post-Acute Care Payment Reform Demonstration (PAC-PRD) which included a component testing the reliability of the standardized items when used in each Medicare setting • 2006: Post-Acute Care Payment Reform Demonstration requirement: • Data to meet federal HIT interoperability standards

4. CARE: Concepts Guiding Principles and Goals:

5. Building the Future State • Assessment Instrument/Data Sets: use of uniform and standardized items • Measures harmonized at the Data Element level • Providers/vendors have public access to standards • Data Elements are easily available with national standards to support PAC health information technology (IT) and care communication • Transfer of Care Documents are able to incorporate uniform Data Elements used in PAC settings, if desired • Measures can follow the person

6. Keeping in Mind, the Ideal State • Facilities are able to transmit electronic and interoperable Documents and Data Elements • Provides convergence in language/terminology • Data Elements used are clinically relevant • Care is coordinated using meaningful information that is spoken and understood by all • Measures can evaluate quality across settings and evaluate intermittent and long term outcomes • Measures follow the person • Incorporates needs beyond healthcare system

7. QIES Assessment DATA

8. QIES Chart QIES Assessment Infrastructure User Tools HART QIES To Success LASER jHAVEN National Reporting A/B/HHH MAC Extract jRAVEN DMS jIRVEN Standard Ad Hoc IRF-PAI OASIS CASPER QIES Work Bench MDS HIS LTCH CARE QIES National DB ASAP Assessment DB CDC

9. Assessment Data • Assessment Software Development • Assessment and Payment Initiatives • Quality Initiatives

10. Assessment Software Development • Nursing Homes – MDS 3.0 • Skilled nursing facilities (SNFs) • Nursing facilities (NFs) • Swing beds (SBs) – non-CAHs • Home Health Agencies (HHAs) – OASIS-C • Inpatient Rehabilitation Facilities (IRFs) – IRF-PAI • Long Term Care Facilities (LTCHs) – LTCH CARE Data Set • Hospice Providers

11. Assessment Software Development • Item Sets (MDS, SB) • Data specifications (all) • Error messages and reports (all) • Validation Utility Tool (all) • Payment groupers (MDS, OASIS, IRF-PAI) • Care planning, e.g., Care Assessment Areas (CAAs) • Public frequency reports (MDS) • QRP (LTCH, IRF, Hospice, HH)

12. Assessment Software Development - General • User Guide Manuals • Vendor calls • Help Desk • Tech email boxes

13. Assessment & Payment Initiatives • MDS • Section S – States • Additional items – States • Money Follows the Person • Survey & Certification • RUG-IV – Center for Medicare • RUG-III – States • A/B MAC extract

14. Assessment & Payment Initiatives • OASIS • Survey & Certification • HHRG • RHHI extract • IRF • Rehab eligibility • CMG • IRF viewer • Claims validation

15. Quality Initiatives • Survey & Certification • Nursing Home Compare • 5-Star Program • Home Health Compare • HHA Pay for Reporting • HH Consumer Assessment of Healthcare Providers and Systems (CAHPS)

16. Quality Initiatives • Quality Reporting Program – ACA 3004 • Data submitted to CMS • LTCH • IRF • Hospice • Data submitted to CDC • LTCH • IRF

17. QIES Chart QIES Assessment Infrastructure User Tools HART QIES To Success LASER jHAVEN National Reporting A/B/HHH MAC Extract jRAVEN DMS jIRVEN Standard Ad Hoc IRF-PAI OASIS CASPER QIES Work Bench MDS HIS LTCH CARE QIES National DB ASAP Assessment DB CDC

18. Data Flow Chart

19. PAC Quality Measures • Measures are strictly specified • Numerator • Denominator • Included / excluded populations • Measures are endorsed by the National Quality Forum • Publicly vetted • Data specifications identifying exact assessment items are posted on web

20. National Quality Forum Endorsement • Measure endorsement process • Concept is important to measure • Measure has scientifically reliable properties (wording of atomic elements is such that 95 out of 100 assessors will get the same answer when coding a response) • Feasibility – the data can be collected under current practice standards • Usability and Use – the information is useful • Related and competing measures – not duplicative and aligned with related measures

21. Assessment Data in Payment/Quality Models • Collect it once, use it multiple times • Assessment items (MDS, OASIS, IRFPAI) are factors in the PPS rates for SNF, HHA, IRFs, respectively • Exact items are used to provide comparable data across providers for rate setting and quality measurement purposes