Coding, once used solely as a way to classify services for billing purposes, is taking on far greater roles in healthcare documentation, especially when it comes to resident assessment data. Longitudinal assessment records are the holy grail for long-term care, both for chronic disease management and for cost utilization benchmarking. But reaching those goals requires data elements that are comparable across care settings.
Every segment of long-term and post-acute care uses a coding system to document care actions and health statuses. Nursing homes use the Minimum Data Set (MDS) coding system, but with MDS 3.0 encompassing more than 9,000 codes, some say it should be called the maximum data set instead. Meanwhile, home healthcare uses the OASIS code set, and long-term care hospitals use the LTCH-CARE coding system.
With the new pressure on data standardization, which code set will prevail? Perhaps parts of all of them, said Tara McMullen, MPH, health analyst in divisions of chronic and post-acute care at the Centers for Medicare & Medicaid Services (CMS) in a session at this week's Long-Term and Post-Acute Care Health IT Summit in Baltimore.
"The lack of data harmonization has been a huge problem for CMS and providers," she said. Although each coding system has its unique elements, some data elements, like vital signs, are captured at nearly every care stage, providing fertile ground for standardization efforts at a national level.
CMS is building a code set library of sorts, the first comprehensive collection of data elements to reach across the links in the long-term care chain. The CMS Assessment Data Element Library will include mapping for all assessment questions and responses, standardized under codes that CMS will accept across any stage in the post-acute care continuum. The work will no doubt use what CMS learned in building the CARE tool, an early attempt at standardized coding following the 2005 Deficit Reduction Act, which mandated the collection of data within acute and long-term care.
Once completed, the assessment data element library will help to reduce the translation barriers that have plagued data-sharing between care environments, McMullen said. Having a central library of codes also will assist the vendor community in developing IT systems and tools that optimize the ability to analyze data for benchmarking and other business needs.
"I get questions from providers every day, asking, 'How will quality affect payments?' I think the day is coming when CMS will begin signalling, but for now there's a lot of work on standardization," McMullen said.
CMS is hoping to launch the data element library in 2015.