The bipartisan, bicameral bill to standardize patient assessments among the four post-acute care providers, known as the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (H.R. 4994/S. 2553) passed by voice vote in both the U.S. House and Senate last week, and is now awaiting signature from the President. If it becomes law, IMPACT would instruct the US Department of Health and Human Services (HHS) to standardize patient assessment data, quality, and resource use measures for postacute care providers including home health agencies, skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals.
Lawmakers see the benefit as a way to compare patient outcomes across industries in the years ahead. Legislation has been approved by the US House of Representatives and is awaiting a vote in the Senate.
Congress appears to be putting off major post-acute pay reforms for at least five years, however this legislation would not preclude Congress from using smaller policies — including value-based pay, rebasing or hospital readmissions — to cut spending and improve pay accuracy.
Once signed, the legislation will:
- Require PAC providers to begin reporting standardized patient assessment data at times of admission and discharge by October 1, 2018, for SNFs, IRFs, and LTCHs and by January 1, 2019, for HHAs.
- Require new quality measures on domains beginning October 1, 2016, through January 1, 2019, including functional status, skin integrity, medication reconciliation, incidence of major falls, and patient preference regarding treatment and discharge.
- Require resource use measures by October 1, 2016, including Medicare spending per beneficiary, discharge to community, and hospitalization rates of potentially preventable readmissions.
- Require the Secretary of HHS to provide confidential feedback reports to providers. The Secretary will make PAC performance available to the public in future years.
- Require MedPAC and HHS to study alternative PAC payment models due to Congress in 2016 and 2021-2022, respectively.
- Require the Secretary to develop processes using data to assist providers and beneficiaries with discharge planning from inpatient or PAC settings.
The congressional committees have provided a summary (.pdf), including timelines.