Medicare Compliance & Reimbursement

New CARE tool to bring major post-acute care placement changes

The Centers for Medicare & Medicaid Services has a demonstration project underway that could change assessment for Medicare patients in skilled nursing facilities, home health agencies, inpatient rehabilitation facilities and long-term care hospitals.

CMS is moving forward with the $6 million Post Acute Care Payment Reform Demonstration (PAC-PRD), mandated by the Deficit Reduction Act of 2005.

The project, scheduled to continue through 2009, will examine the costs and outcomes for similar diagnoses across the four different post-acute care settings listed above.

The ultimate goal behind this project is to optimize patient care. "The central concept of CMS' vision for post-acute care is that the system will become patient-centered; that is, the system will be organized around the individual's needs, rather than around the settings where care is delivered," stated a 2006 CMS Policy Council Document on the Post-Acute Care Reform Plan.

"We [healthcare providers] might assume that a high-functioning CVA [stroke] patient could go straight home [from acute care] and be okay, and a truly lower-functioning CVA patient might go, perhaps, to a SNF," says Laurel Cargill Radley, MS, OTR, associate director of professional affairs for the American Occupational Therapy Association. "But these assumptions about discharge planning may not be the best, and this reform will help us understand how to do better discharge planning--and get the patient to the outcomes they need."

Another "key goal of this project is to generate recommendations for improving CMS payment models," CMS said in the release. So the PAC-PRD demonstration results "may influence how Medicare pays for care across PAC settings and how patient assessments occur at hospital discharge and through subsequent PAC settings."

The different post-acute care settings get Medicare reimbursement based on their own patient assessment tools. Skilled nursing facilities use the Minimum Data Set (MDS) assessment, home health agencies use the Outcome And Assessment Information Set (OASIS), and inpatient rehab facilities use what's called the IRF-PAI (inpatient rehab facility-patient assessment instrument). Long-term care hospitals don't have an established tool.

With all these different assessment tools floating around, CMS is hoping this demonstration project might shed light on the development of a brand new tool that all post-acute settings could share.

CMS believes a standard assessment tool will help patients receive the care that they need. But this could be either good or bad news for the post-acute settings themselves. For example, if CMS discovers that skilled nursing can provide the same patient outcomes for much less cost than, say, home health, CMS may encourage more patients to utilize skilled nursing.

To launch the PAC-PRD, CMS created a patient assessment tool for the acute hospital at discharge and for the PAC setting admission and discharge. After holding technical expert [...]