IMPACT Act Brings Post-Acute Care Transitions to the Forefront

by Mary Kay Thalken, RN, MBA on May 30, 2016

Through the use of standardized quality measures and standardized data, the intent of the IMPACT Act, among other obligations, is to enable interoperability and access to longitudinal information for such providers to facilitate coordinated care, improved outcomes, and overall quality comparisons.

Quality Measure Domains:

  • Skin integrity and changes in skin integrity
  • Functional status, cognitive function, and changes in function and cognitive function
  • Medication reconciliation
  • Incidence of major falls
  • Transfer of health information and care preferences when an individual transitions
Click here for Resource Use and Other Measure Domains.

By the end of 2014, 97 percent of all U.S. hospitals had met the foundational requirement of Meaningful Use 1 by having installed certified electronic medical records (EMR) technology. This achievement marks an important first step in the Centers for Medicare & Medicaid Services’ (CMS’) wide-scale effort to construct the technology infrastructure needed to bring the first real change to healthcare in decades. This foundation is absolutely essential to support the relentless drive toward a fee-for-value system.

A system that once rewarded hospitals financially for doing more procedures, is now demanding that if these procedures be done, they are done well. This greater push toward value brings the challenge of how to standardize communication among disparate providers to ensure patients receive the continuity of care required to prove and achieve quality outcomes.

As a result, healthcare organizations today are scrambling to keep up with the many new government initiatives, measurement, reporting, subsequent penalties, and standardization required to compete in the changing environment. The foundational investment made in the EMR was just the beginning. The challenge now is to make that system, and the many disparate systems that are used throughout the care continuum, to somehow speak a mutually agreeable vocabulary.

The truth is, providers didn’t need to be able to communicate using a standardized language under the old fee-for-service payment system. Everyone was out for his or her own bottom line and total costs were never an important consideration. That is no longer the case.

One initiative that should be top-of-mind to healthcare stakeholders is the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, the bipartisan initiative passed into law October, 2014. The law intends to change and improve Medicare’s post-acute care (PAC) services and how they are reported. Not only does the Act promote interoperability across disparate technology platforms, it represents the first time that CMS has attempted to unite various healthcare stakeholders and providers with a shared data vocabulary.

Specifically, the Act requires the submission of standardized data by Long-Term Care Hospitals (LTCHs), Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs) and Inpatient Rehabilitation Facilities (IRFs) on specific quality measure domains beginning in October 2016. The first penalties for non-compliance (up to 2 percent) come October 2018.

Among the quality measure domains is one that very specifically acknowledges the importance of care transitions. Specifically, measurements will be required around the transfer of health information and care preferences when an individual transitions from one care setting to another.

The heightened focus on care coordination is an important place to focus not just to help hospitals manage the increasing financial risk, but also to ensure positive long-term outcomes for patients. Maintaining oversight of patients after they leave the hospital, making sure patients are placed in the most appropriate post-acute setting for their clinical and psychosocial needs, enabling access to hospital- and community-based services and engaging the patient in his own care are all important aspects of the healthcare transformation that is happening as we speak.

The Act also implies the veritable importance of giving the patient choice in their care decisions and as a result, developing ways to document the extent to which patients were involved in managing decisions about their care.

Oversight, enablement and the ability to monitor patient choice is virtually impossible without technology. The truth is, enough people can never be hired to stay on top of these complicated, albeit critical, transactions. Technology solutions designed to safely and systematically transition patients from one care setting to another, and tools designed to assist the patient in family in making informed decisions about the next steps in their care will not only be essential, but mandated.

Is your organization ready?

Meet the Author

Thalken brings more than 30 years of experience in health-care leadership to our company. Prior to joining the company, she served as Enterprise Vice President for Care Logistics in Atlanta, Ga. She has held executive leadership positions at hospitals in Nebraska and Iowa, including the position of System Quality Executive for Alegent Health. Thalken has presented on the topics of improving quality, patient flow and throughput at various industry conferences and webinars. Thalken holds an MBA from the University of Nebraska at Omaha. She is a member of the American College of Healthcare Executives, American Organization of Nurse Executives and American Case Management Association.