Hospitals object to collecting their own data as part of post-acute reform, urge revisions to draft legislation

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House Ways and Committee Chairman Rep. Dave Camp (R-MI)
House Ways and Committee Chairman Rep. Dave Camp (R-MI)

Hospitals should not be required to collect patient assessment data as part of an effort to revamp post-acute care, the leader of the American Hospital Association argued in a recent letter to top Congressional lawmakers. 

The Senate and House of Representatives unveiled draft legislation last month that aims to create more uniformity in post-acute care — for example, by standardizing patient assessment data furnished by different provider types, such as inpatient rehabilitation hospitals and skilled nursing facilities. Acute care hospitals also would be required to collect patient assessment data prior to discharge, which could be used to inform post-acute care and measure patient outcomes.

Members of the hospital association believe that collecting this data would be prohibitively complicated, in part because they could not “rely solely” on an electronic health record to capture it, AHA Executive Vice President Rick Pollack wrote in a May 12 comment on the draft bill. The hospital data collection requirement should be removed from the legislation, he recommended to the committee leaders behind the measure.

Pollack praised the intention of integrating post-acute payments by focusing on conditions being treated rather than the setting where treatment is occurring, but balked at the logistics of making this happen. Each setting serves “a different mix of patients and offers distinct services,” he wrote. For instance, the legal settlement in the Jimmo case means that skilled nursing facilities now can be reimbursed for therapy to maintain a resident's condition, while other post-acute providers must demonstrate the potential for improvement, he stated.

Regulators should implement a risk adjustment system to account for the different clinical risk factors being faced by particular providers, Pollack urged. Risk factors would include patient age and comorbid conditions. Cross-setting comparisons should be prohibited until proper risk adjustment methodologies are developed, Pollack argued.

The Senate Finance and House Ways and Means committees introduced the draft version of the “Improving Medicare Post-Acute Care Transformation Act of 2014.” Pollack addressed his letter to Finance Committee Chairman Sen. Ron Wyden (D-OR) and Ranking Member Sen. Orrin Hatch (R-UT), and Ways and Means Chairman Rep. Dave Camp (R-MI) and Ranking Member Rep. Sander Levin (D-MI).