With skilled nursing facilities preparing for an Oct. 1 deadline for new quality measures, government officials are emphasizing their focus is to make quality the basis for value.
“Quality is the foundation for all that you will see moving forward,” said Shari Ling, M.D., deputy chief medical officer, Center for Clinical Standards and Quality at the Centers for Medicare and & Medicaid Services, speaking with a panel of experts at the LTPAC HIT summit Monday in Reston, VA. The session followed a 4.5 hour presentation Sunday from CMS on the IMPACT Act and Assessment Data Element Standardization.
For skilled nursing facilities, the fall deadline marks when they should start standardized data submissions for sections such as functional status/cognitive function/changes in function and skin integrity/changes in skin integrity. Other measurements, such as medication reconciliation, will begin Oct. 1, 2018. For complete information on timelines, click here.
The traditional challenge with measuring quality is that different industries — home health, SNFs, inpatient rehabilitation facilities and long-term care acute hospitals — have not collected data in the same way. In order for long-term care to achieve interoperability and ensure standardization, data has to be comparable at every level and assessed via the same scale, explained Tara McMullen, Ph.D., Quality Measures and Health Assessment Group, Center for Clinical Standards and Quality at CMS. While standardization is not a new concept, the IMPACT Act focuses on enabling uniformity, she noted.
“It’s about looking at what a person needs in the setting in which they need it,” she said Sunday.
In addition to improving quality among SNF residents, one huge reason why the measures matter to providers relates to payments. By 2018, SNFs that do not report their quality measurements could face a 2% reduction in payments. Additionally, providers within a bundled payment model are “now interdependent on each other’s information,” said CMS Enterprise Lean Lead and Health IT Advisor Kevin Larsen, M.D.
“We all need each other’s information to understand our financial risk” he said.
Yet interoperability is “not just about exchanging information,” Larsen added. Through 2017, an interoperability goal is to use priority data domains to improve quality. Beyond that, it’s to expand data sources and users in an interoperable health IT ecosystem to improve health, he explained.
“We’re not just producers of information; we are mutually responsible for the information, not just shoving it out of our system,” he said.
As a physician, he noted it wouldn’t have been in his purview to measure outcomes, such as who was cured from an antibiotic. High blood pressure is another sore spot in a fee-for-service system, as patients may change healthcare providers without anyone tracking if they are improving. If a SNF resident is discharged to home care, the facility may not know. Similarly, one goal for the Medicare population is for advance directives to follow a beneficiary, whether she is in an ambulance or the hospital.
Proactive and reactive information has to be shared and “data needs to get back to the person who made a critical decision,” Larsen said.
In a later session, Dave Wessinger, PointClickCare co-founder and chief technology officer said interoperability is now reaching beyond transitions of care to “real-time data generating alerts.”
It’s about how “the second you take a vital, this partner wants it in their system so their hospitalist can interact with it,’ he said. “There are a lot of models evolving. It’s the wild West right now.”
The summit, held at the Hyatt Regency Reston, continues Tuesday with sessions that include healthcare claims data, e-prescribing, telehealth, and privacy and security compliance.
