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Post-acute care groups applaud passage of IMPACT Act

September 22, 2014
by Lois A. Bowers, Senior Editor
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Organizations serving older adults say they are pleased with Congress’ passing last week of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, which is designed to standardize data used across post-acute care (PAC) settings, enabling payments and patient outcomes to be compared across skilled nursing facilities, home health agencies, inpatient rehabilitation facilities, long-term care hospitals and other providers. The legislation now awaits the president’s signature.

“This bill is about transparency in the areas of cost and quality, providing consumers and government-critical information regarding outcomes and cost. We are very pleased with this outcome,” Mark Parkinson, president of the American Health Care Association/National Center for Assisted Living (AHCA/NCAL), said in a statement.

IMPACT, also known as HR 4994, will standardize assessments for critical care issues in areas such as functional outcomes, pressure ulcers and dementia, enabling the development and public reporting of quality measures for providers. It also requires the Medicare Payment Advisory Commission (MedPAC) to provide Congress with new models for PAC payments, including bundled and site-neutral payments.

The legislation eliminates “the silo-focused approach to quality measurement and resource utilization,” said AHCA/NCAL Senior Vice President of Government Affairs Clifton J. Porter II.

LeadingAge said it is behind the act, with stipulations. The organization supports standardized assessment “on the condition that it is integrated and not just an add-on to existing assessments (MDS, OASIS, etc),” Cheryl Phillips, MD, senior vice president of public policy and advocacy for LeadingAge, told Long-Term Living. “Additionally, the inclusion of meaningful risk-adjustment for any payment incentives or penalties is vitally important. We at LeadingAge have stated strongly that there needs to be both provider-level risk adjustment to account for socioeconomic and other geographic issues that impact these measures, and beneficiary-specific risk adjustment to account for co-morbidities and pre-event functional limitations.”

The Partnership for Quality Home Healthcare (PQHH) also expressed pleasure that the bill had passed Congress.

“Consistent and comparable data collection on patient assessment and outcomes is key to this outcome and, along with patient-centered PAC bundling, holds great promise in reducing costs and improving outcomes for the sustainable preservation of the Medicare program,” Eric Berger, PQHH CEO, said in a statement.

PQHH also supports the Bundling and Coordinating Post-Acute Care (BACPAC) Act of 2014 (HR 4673), which would establish bundled payments for PAC services covered by Medicare and, PQHH says, would ensure patients are receiving care in the most cost-efficient setting. “Much like the IMPACT Act, the BACPAC Act offers patient-centered solutions to reform Medicare and improve quality and care coordination for Medicare beneficiaries,” Berger said.

The National Hospice and Palliative Care Organization (NHPCO) said it also supports the IMPACT Act and the additional oversight it will bring to end-of-life care providers.

The legislation requires more frequent surveys of hospice providers, a measure that NHPCO says it and other hospice organizations have championed for more than a decade. The bill mandates that all Medicare-certified hospices be surveyed every three years for at least the next 10 years.

“Currently, hospices can go eight years or more without ever being surveyed, which is far too long,” J. Donald Schumacher, NHPCO president and CEO, said in a statement. “More consistent surveys, and the process providers go through to prepare for them, will help hospices and ultimately benefit the patients and families in their care.”

The new legislation also will facilitate medical reviews for select hospice programs, with a soon-to-be-determined percentage/number of patients/residents receiving care for more than 180 days. The specific patient load that would trigger this medical review is yet to be set by the Centers for Medicare & Medicaid Services, NHPCO notes. Such a medical review of what are known as “long-stay” patients/residents will help ensure that hospices are appropriately caring for individuals with life-limiting illnesses that are often more difficult to prognosticate than in the earlier days of hospice provision when most patients/residents had a cancer diagnoses, according to the organization, which says that it has supported this provision since MedPAC originally recommended it in 2009.

The legislation also includes a provision that would align hospice reimbursement and the hospice aggregate financial cap to a common inflationary index.