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Medicare-Acute Care, Moving Beyond the Silos

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Notes

Recorded at the UTMB Health Policy Lecture Series, 2014. Presented by Barbara J. Gage, PhD, MBA Managing Director, Engelberg Center for HealthCare Reform and Fellow of Economic Studies, The Brookings Institute. Dr. Gage discusses the Affordable Care Act's aim to improve quality of care and bring down costs as well as assessments and instruments to examine care.

Learning Module Notes Modules

  1. Introduction - Crash course of context in today’s post-acute care environment (0:00 - 6:34)     
    • ACA’s Triple Aim: Focus on the individual, improve quality of care, bring down costs
  2. Example: Quality adjustments take to reshape payments & share in healthcare savings (3:56-4:43)
  3. Why Care? - Medicare covers 47.6 million people (4:43-10:38)
    • Population stats
    • Distribution of expenses
  4. Example: Data looking at patterns in post-acute care use in 2006 (10:38-11:25)
  5. Deficit Reduction Act of 2005 (11:25-13:12 )
    • Single comprehensive assessment 
    • Standardized assessments Developed the Continuity Assessment Record and Evaluation (CARE) Item Development 
    • Aim: Standardize assessment in acute care across disciplines to pull out population similarities
  6. Similarities & Differences Among Current Instruments (13:12-14:06)
  7. Example: Comparison of Tools (14:06-15:58 )
    • Functional Status
    • FIM: Used in acute care
    • MDS: Used in SNF
    • OASIS
    • CARE Tool
    • Barthel Index
  8. Solution: CARE Tool Functional Status Coding (15:58-18:06)
    • Rate 1-6, 1 = dependent, 6=independent for ALL patients
    • Standard language important to improve coordination of care & data exchangeability
  9. Standardizing CARE Across Settings: (18:06-20:37)
    • How to standardize framework for CARE Patient Assessment Items
    • CARE Reliability Results: Inter-rater reliability tests, clinician agreements across settings
    • Findings show results were reliable, report to congress
  10. Outcomes: (20:37-36:24 )
    • Sample Overview: 200+ providers, geographically diverse, variable PAC markets, 53,000+ assessments
    • Examined 3 constructs: Resource intensity, outcomes, discharge destinations
    • Independent variables examined
    • Take Home: Case-mix (sample) matters! Can’t generalize
  11. How are these results used? (36:24-44:25)
    • PAC PRD Results used by: Medicare, CMS, congress (quality metrics & regulations)
  12. Q&A (44:25-51:56)
  Learning Modules