FutureFocus March 14, 2018 - Quality Data And Discharge Planning: Changes Ahead

Lisa Remington

In this week’s FutureFocus, we provide insights into how quality data influences discharge planning. Ongoing discussions at MedPAC are evaluating current discharge planning procedures and the future of the IMPACT Act for PAC providers. In another article, we focus on  Medicare reimbursement changing for physicians and new opportunities for post-acute providers to integrate chronic care management solutions. We provide resources and insights to tackle the topic. In the news, is talk about social determinants and the responsibility of providers. Learn how health systems, ACOs and payors are looking at different solutions.

Lisa Remington, President, Remington Health Strategy Group

Publicly available quality data is rarely a factor in Medicare beneficiary choice of a post-acute care (PAC) provider, according to Medicare Senior Policy Analyst Evan Christman.

“In practice, beneficiaries report relying on information from trusted sources like health care providers, families, or others that may have experience with PAC,” Christman told the Medicare Payment Advisory Commission (MedPAC) March meeting in Washington.

“These trusted intermediaries are often considered by beneficiaries to be more important sources of information than Medicare's publicly reported quality data,” such as available on Nursing Home Compare and Home Health Compare. “Factors such as distance from a beneficiary's home and community reputation are commonly cited by beneficiaries as important when selecting a provider. Beneficiaries report that they would like to receive more advice” from hospital discharge planners, but “discharge planners cannot make recommendations.”

"The Balanced Budget Act of 1997 requires hospitals to provide beneficiaries with a list of SNFs and HHAs nearby, but the list is not required to include quality information." 

Most SNF and HHA users had a nearby provider of higher quality, according to a study by MedPAC staff. For each patient selected, it was determined how many providers with a better performance on a composite measure were operating within 15 miles of the beneficiary's residence:

  • SNF: 84.3 percent of beneficiaries had at least one higher-quality SNF nearby; 46.8 percent had 5 or more.
  • HHA: 94.5 percent of beneficiaries had at least one higher-quality HHA nearby; 69.5 percent had 5 or more.
  • Beneficiaries in urban areas generally had more higher-quality options nearby.

Higher-quality providers “had meaningful differences” compared to other providers, such as significant differences in re-hospitalization rates. “This has real consequences for beneficiaries, as those served by low-quality providers will have more hospitalizations and likely have worse clinical outcomes.”

Christman added that “for some conditions, it will also mean that hospitals face steeper penalties under programs like the Hospital Readmissions Reduction Program.  And, in addition, Medicare receives less value for the PAC care it buys, and spends more on re-hospitalizations than it should have to.”

Could Be Corrected by IMPACT Act, but No Regs Yet

The Balanced Budget Act of 1997 requires hospitals to provide beneficiaries with a list of SNFs and HHAs nearby, but the list is not required to include quality information. “Medicare statute provides beneficiaries with the freedom to choose their PAC provider, and the laws states that hospitals may not recommend providers,” Christman noted.

The IMPACT Act (Improving Medicare Post-Acute Care Transformation Act of 2014) created a new requirement that hospitals use quality data during the discharge planning process and provide it to beneficiaries. But regulations implementing this new requirement have not been finalized.

MedPAC Commissioners discussed two options for providing this authority: a “flexible approach” whereby hospitals would collect and provide quality data on PAC providers; and, a “prescriptive approach” in which Medicare would develop a single quality standard and would notify hospitals and beneficiaries of qualifying PAC providers.

MedPAC plans to include discussion of this topic, and possible solutions, in its June 2018 report to Congress on Medicare and the Health Care Delivery System.

For more information on discussions about discharge planning.

By: Ronald M. Schwartz, Writer, The Remington Report.