Renee Kinder

The new year is upon us. 

What new areas of regulatory change will your teams monitor in 2022?

CPT? Parity? Survey trends? Quality?

Yes, obviously quality, Renee, but the future of quality…  where would we start? 

Remember when I wrote to you all in a January 2017 blog titled, “Is your rehab partner wearing blinders?” that there was likely a shift occurring in post-acute care payment reform AND the fact that there was a technical expert panel (TEP) in place providing feedback and guidance to CMS? 

An excerpt from that blog here:

The Centers for Medicare & Medicaid Services has consulted with Acumen in an effort to establish a comprehensive approach to Medicare Part A PPS SNF payment reform.

An updated report from the TEP October face-to-face meeting at CMS headquarters was recently published.

Project aims include efforts to:

•  Develop a comprehensive payment alternative for SNF services that promotes payment accuracy and positive resident outcomes

•  Assess the impact of the payment alternative on SNF residents, SNF providers, and the overall Medicare system

•  Recommend adjustments for adoption by CMS

The recommended structure could change from current volume-based reimbursement that considers therapy; nursing; and non-case mix to a system based on patient characteristics that considers payments in “buckets” for the following areas: physical plus occupational therapy; speech language pathology; nursing; non-therapy ancillary; and non-case mix.

Well, great news!

Here we are wrapping up 2021, two years after that TEPs work led to the implementation of PDPM and the Centers for Medicare & Medicaid Services (CMS) has recently announced two new technical expert panels (TEPs) focusing on key areas of quality.

First:  Technical Expert Panel (TEP) for the Refinement of Long-Term Care Hospital (LTCH), Inpatient Rehabilitation Facility (IRF), Skilled Nursing Facility (SNF)/Nursing Facility (NF), and Home Health (HH) Function Measures

Project Overview: The Centers for Medicare & Medicaid Services (CMS) has contracted with Acumen, LLC and Abt Associates (hereafter referred to as Acumen and Abt respectively) to develop quality and cost measures for use in Post-Acute Care (PAC) Quality Reporting Programs (QRPs) as mandated by the Patient Protection and Affordable Care Act (PPACA) of 2010 and the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. 

Acumen’s contract name is “Quality Measure & Assessment Instrument Development & Maintenance & QRP Support for the Long-Term Care Hospital, Inpatient Rehabilitation Facility, Skilled Nursing Facility, Quality Reporting Programs, & Nursing Home Compare.” The contract number is 75FCMC18D0015, Task Order 75FCMC19F0003. 

Abt’s contract name is “Home Health and Hospice Quality Reporting Program Quality Measures and Assessment Instruments Development, Modification and Maintenance, & Quality Reporting Program Oversight Support.” The contract number is 75FCMC18D0014, Task Order 75FCMC19F0001.

Second:  CMS Quality Measure Development Plan and Quality Measure Index

Project Overview: The Centers for Medicare & Medicaid Services (CMS) has contracted with Health Services Advisory Group, Inc. (HSAG) to develop and update the CMS Quality Measure Development Plan under Measure & Instrument Development and Support (MIDS) contract #75FCMC18D0026, Impact Assessment of CMS Quality and Efficiency Measures Task Order #75FCMC19F0001. The CMS Quality Measure Development Plan (MDP) serves as a strategic framework for clinician quality measure development to support the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs), known collectively as the Quality Payment Program. 

As a separate component of the Impact Assessment Task Order, HSAG is developing and refining the Quality Measure Index (QMI) to support the assessment and selection of quality measures that provide meaningful quality performance information and align with the national healthcare quality priorities. HSAG is convening patients, caregivers, clinicians, and other experts to provide input on the QMI project and the annual progress reports required under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Convening the TEP is an important step that ensures transparency and obtains balanced input from multiple stakeholders.

What is a Technical Expert Panel (TEP)?

  • To begin, as you recall TEPs were used to assist in the development of the Patient Driven Payment Model (PDPM) and the Patient Driven Groupings Model (PDGM).
  • A TEP is a group of people with diverse professional and personal experiences who provide input to quality measurement projects. For measure development projects, a TEP provides CMS feedback to measure developers during each stage of the measure development process.
  • TEPs are considered a best practice for all projects that address clinical quality in some capacity. 
  • TEPs are one of the most common stakeholder engagement methods.

What do TEPs do when they meet?

To support quality measurement activities, TEP members use their knowledge and experience to:

  • Review new measure ideas and help decide which ones should be developed further
  • Review results from the testing of measures that are currently being developed
  • Advise the measure developer on which measures should be recommended to CMS based on criteria, including if patients will find the measure(s) meaningful and important
  • Provide stakeholder feedback about uses and needs for public resources and measures, such as Care Compare
  • Give feedback on other quality measurement topics

Sounds great, Renee, but who can join a TEP? 

Per CMS, to receive balanced input, measure developers or other groups seeking advice invite eight to 15 people with varying perspectives to join their TEP.

Although TEPs could be intimidating, it is critically important that patients, family members, and caregivers participate in TEPs because their lived experiences provide invaluable insight into healthcare.

Members of past TEPs have included the following:

  • Patients, family members and caregivers
  • Experts with experience relevant to the measure being developed or maintained
  • Clinicians
  • Electronic Health Records (EHR) Vendors
  • Other measure developers
  • Statisticians
  • Quality improvement experts
  • Methodologists
  • Representatives from relevant stakeholder groups
  • Others interested in quality measurement with relevant experience

In closing, add the work of these two TEPs to your list.

Follow their work, plan accordingly, and this time around don’t be the provider wearing blinders!

Renee Kinder, MS, CCC-SLP, RAC-CT, is Executive Vice President of Clinical Services for Broad River Rehab and a 2019 APEX Award of Excellence winner in the Writing–Regular Departments & Columns category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association’s (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty and is an advisor to the American Medical Association’s Current Procedural Terminology CPT® Editorial Panel. She can be reached at [email protected].

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.