- Despite major strides in aligning post-acute care and long-term care measures, notable gaps remain, particularly in care coordination and data transfer, a new report by the National Quality Forum's Measure Applications Partnership concludes.
- In particular, the report stresses the need for care coordination in PAC and LTC patients, who often move back and forth between those sites for care.
- The report also points to challenges in advancing team-based care and shared accountability in models that focus on physician care and recommends inclusion of additional clinicians such as physical and occupational therapists in the Merit-Based Incentive Payment System.
While the Trump administration’s focus is on rolling back regulations, there are risks in loosening government oversight of healthcare programs. Providers applaud less regulatory and reporting burden, but those regulations were established in many cases to promote greater care quality or to reduce unnecessary procedures.
The Improving Medicare Post-Acute Care Transformation Act (IMPACT), enacted in 2014, standardized collection of assessment data across settings to make it easier to compare performance results and improve communication. The law requires post-acute care providers to report standardized patient assessment data, as well as data on other key quality and efficiency measures. For example, providers are required to consider total Medicare spending per beneficiary and successful discharge back into the community.
MAP calls for measure developers to focus on four care coordination measures for PAC/LTC: timeliness of information transfer; electronic exchange of clinical information; advanced care planning, especially around chronic diseases; and two-way data exchange measures that note whether information was sent and received and if the receiver responded with follow-up questions.
The report also stresses the importance of patient-reported, outcome-based performance measures in improving overall care.
Specifically, MAP looked at the CoreQ: Short Stay Discharge Measure, which calculates the share of short-stay residents who are satisfied at the time they are discharged from a skilled nursing facility. Among the gaps identified were a need for bidirectional measures that hold both referring providers and nursing homes accountable for care, as well as measures on detailed advance directives on patient preferences for life-saving or life-sustaining interventions.
“NQF, and the MAP, are focused on getting to high-value, meaningful measures to improve care and outcomes for our nation’s 55 million Americans who rely on Medicare,” Shantanu Agrawal, president and CEO of NQF, said in a statement. “These latest recommendations are about getting to actionable, meaningful information for patients and clinicians, while minimizing unnecessary burden for reporting and using quality improvement measures.”
NQF was created in 1999 after a presidential panel suggested a group to promote quality public reporting in health care was needed.