The IMPACT Effect: Fixing Post-Acute Care Fragmentation

Published June 27, 2016

The post-acute care (PAC) delivery system is fragmented, characterized by inconsistent standards of care and variations in payment rates across settings. Patients are directed to PAC providers driven by a number of local market factors, including availability and physician preference. And there is little standardization of patient placement based on acuity. A lack of consistent reporting, quality data, patient assessments and discharge planning processes has resulted in a siloed system that impedes care coordination and improved outcomes.  Although these are perennial, systemic issues, it took a $60B Medicare PAC price tag in 2013 before policy makers took action.

The Improving Medicare Post-Acute Care Transformation Act (IMPACT) of 2014 aims to increase transparency and improve care coordination, continuity of care and quality across the spectrum of PAC providers including Home Health Agencies (HHA), Skilled Nursing Facilities (SNF), Inpatient Rehabilitation Facilities (RF) and Long Term Care Hospitals (LTCH). In order to provide a more accurate view of PAC usage and enable the development of a more efficient payment model, the Act requires PAC providers to report standardized data on patient assessments, quality measures and resource use and to make data interoperable. Furthermore, the Act attempts to strengthen and redirect hand offs from one PAC setting to another by mandating the use of quality ratings when discharging patients from referring hospitals and requiring person-centered care plans, medication reconciliation lists, and post discharge needs assessments.

The IMPACT Effect will hasten the integration of the PAC care continuum and break existing barriers to care coordination and improved outcomes. Once fully implemented, it will be the ultimate validation of an integrated home-centric PAC delivery model in which an accountable organization manages the full continuum of care post discharge, redirects patients to the most appropriate site of care, and thus, enables patients that can go home to go home faster, safer, and with the right supports. In this model, the scope of home health care will be expanded to include the coordination of additional services including home infusion services, DME, preventive care, and chronic care management services.

To effectively improve value for payers and patients, this integrated, home-centric model must be built upon a strong foundation of data and analytics. Care transition decisions must be based upon an extensive, outcomes-based data set and facility specific quality metrics by disease category to determine the best care setting and the best provider for each patient based upon an assessment of their individual medical and social needs. The result will be to effectively maximize the home as a preferred setting of care thus improve quality and reduce total per episode costs by reducing readmissions, PAC facility usage, and ER visits.
Another important by-product of this system, not to be overlooked, is improved patient satisfaction.  Among the general population of 50 and over, a majority prefer care at home.

The IMPACT Act’s focus on greater consistency and transparency in quality and cost data reporting, increased uniformity in patient assessment and discharge planning tools coupled with the MedPAC recommended site neutral reimbursement changes, will strengthen an industry too long enmeshed in a sea of incongruity.  These changes will only serve to enable and validate the potential of an integrated home-centric model of post-acute care and, thus, improve the PAC value equation.