Discussion
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Module8Notes.docxModule 8 Notes
In Modules Six and Seven, we examined Medicare-Medicaid reimbursement payment systems based on inpatient and ambulatory services. In Module Eight, you will review the plans for patients seeking post-acute care (PAC). PAC includes services that are provided to individuals at a long-term care hospital (LTCH), inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), and home health agencies (HHA). There are various models and policies of payment under each facility. The key point to remember as a healthcare administrator is that Medicare pays differently based on the type of setting (Medicare Payment Advisory Commission, 2014).
Key Legislation for Post-Acute Care
Prospective payment systems are driven by Medicare requirements for PAC to ensure that appropriate, high-quality care is delivered at a cost that is appropriate for the condition. In 2014, Congress passed the Improving Medicare Post-Acute Care Transformation Act (IMPACT) that provided a way to standardize how patient care is assessed across the various facilities (Centers for Medicare & Medicaid Services, 2015). IMPACT requires PACs to report standardized quality, assessment, and resource use measures. The reports allow the Centers for Medicare & Medicaid Services (CMS) to formulate comparisons across providers. Comparisons are important to patients and family members when trying to decide what facility to select. For example, you might be looking for a nursing facility for an elderly family member, and you are not familiar with the geographical area. In this case, you can go to the CMS website and find ratings for nursing facilities.
Data Collection and Reporting
In an effort to provide a way to compare one site to another, Medicare has established reporting requirements that force healthcare facilities to provide specific data. Some of the instruments used to collect data include:
· Minimum Data Set (MDS): The MDS is a standardized screening and assessment tool used to evaluate the functional capability of residents in Medicare- or Medicaid-certified nursing homes.
· Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI): The IRF-PAI instrument is used to measure data on fee-for-service patients requiring inpatient rehabilitations services based on physical, cognitive, functional, and psychosocial factors.
· Outcome Assessment Information Set (OASIS): The OASIS is used to measure patient risk factors and outcomes for care provided by home health agencies. The data criteria include sociodemographic, environmental, health status, support system, functional status, and utilization aspects of the patient. Data is collected at the start of care, 60-day follow-ups, and discharge.
Healthcare organizations collect and report data to a wide variety of public and private organizations. First, data are collected for use internally by management for operational and strategic planning. Next, data are collected for relevant stakeholders and for disclosure purposes of external audits. Data are also collected to meet accreditation requirements and for benchmarking of state and government programs. For example, in this report , data collection from the Agency for Healthcare Research and Quality is described.
Data that are collected include societal, environmental, health status, support system, functional status, and behavioral status. For example, a home health nurse will collect data at the start of care and with each visit, noting significant changes in condition and length of therapy provided from appointment to appointment. The structure of payment for this type of care would be based on the national standardized episode rate. This rate is predetermined based on a calculation of home health payment. The base rate is derived from data retrieved on audited cost reports on covered home health services.
In this module, you will continue working on your final project, which will be submitted in Module Nine. Please review the CMS website to find information on reimbursement to assist with the recommendation portion of your final project. Additionally, you will find information on instruments for collection and reporting requirements.
Next Steps
There are many opportunities for employment in healthcare administration, as evidenced by the various facilities covered throughout Modules Six, Seven, and Eight. In Module Nine, you will continue to evaluate the policies and procedures that administrators can use as tools to help organizations meet standards of operation and performance.
References:
Centers for Medicare & Medicaid Services. (2015). IMPACT Act of 2014 & cross setting measures. Retrieved from <https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/IMPACT-Act-of-2014-and-Cross-Setting-Measures.html
Medicare Payment Advisory Commission (MedPAC). (2014). A data book: Health care spending and the Medicare program. Retrieved from http://medpac.gov
