By Maggie
Flynn | September 26, 2019 Alex Spanko / Aging Media Network
The
federal government issued a final rule on Thursday requiring hospitals to give
patients access to more information about the post-acute provider choices
available — including data on how their post-acute options perform on quality
measures such as pressure ulcers, falls, and readmissions.
This new rule will not have any impact on
anti-steering regulations that prevent hospitals from recommending specific
skilled nursing facilities, Centers for Medicare & Medicaid Services (CMS)
Administrator Seema Verma stressed on a press call Thursday.
“This
is really about making sure the patient has information about what happened, in
the hospital,” Verma said on the call. “And so when they do go to a post-acute
provider, that they are able to have that information for the provider.”
The
Medicare Payment Advisory Commission (MedPAC) sounded the alarm on the quality
of the post-acute facilities patients where patients go after hospital stay
last year in its March 2018 public meeting and in its report to Congress that same month.
“Medicare
statute provides beneficiaries with the freedom to choose their PAC provider,
and the laws state that hospitals may not recommend providers,” MedPAC senior
analyst Evan Christman said in his presentation in the meeting. “The
IMPACT Act created a new requirement that hospitals use quality data during the
discharge planning process and provide it to beneficiaries. But regulations
implementing this new requirement have not been finalized.”
That
changed Thursday, with the final rule specifically implementing the
requirements from the Improving Medicare Post-Acute Care Transformation Act of
2014 (IMPACT Act). As a result, hospitals have to
help patients, their representatives, and families by sharing data on quality
measures for home health agencies (HHAs), SNFs, inpatient rehab facilities
(IRFs), or long-term care hospitals (LTCHs) — in a way that’s relevant to
patient goals of care and treatment preferences.
The new
regulation will also boost interoperability by requiring that patients be able
to access their medical records in the format of their choice, Verma said on
the call.
“This
requirement will ease communication between acute and post-acute care care
providers,” she said.
Under
the rule, the hospitals can’t specify or limit the qualified providers
available to patients, and CMS emphasized that the anti-steering provisions
affecting hospitals have not changed because of the final rule.
Those
provisions have been a source of headaches when it comes to patient transfers. Multiple reports have indicated that hospitals feel
hamstrung by provisions of various laws guaranteeing freedom of choice to
patients, at least when it comes to providing more information about the
quality of post-acute providers in a given area.
One
study in Health Affairs, published in August 2017, found that patients
don’t receive quality-of-care data about SNFs when they are discharged from the
hospital. In most cases, in fact, people would receive lists of SNFs within
their city with minimal information about the facilities.
Hospitals
might not have been aware that they could help patients in choosing
better-quality facilities without restricting their choice, author Denise Tyler
told Skilled Nursing News at the time.
“The
statute simply says people should not be restricted in their providers,” she
said. “A hospital that gives a list of facilities but points out which ones are
vetted and of superior quality is still a choice, but a more informed choice.”
The
United Hospital Fund also called out the confusion over legal mandates in a November 2018 report on care transitions to
post-acute care. The group noted that federal regulations allow hospitals to
refer patients to resources such as Nursing Home Compare or official state
websites for information about post-acute providers, as well as permitting hospitals
to help patients interpret quality-related information. However, that
regulation does not specifically require acute care providers to do so.
“This
distinction between permitting and requiring the provision of information about
PAC providers can get lost on the ground, when hospitals concerned about
compliance may err on the side of legal caution,” the UHF noted in its report.
“Narrow interpretation of the regulations has led many discharge planners on
the frontlines to be cautious about providing much assistance or advice to
patients and families beyond distributing lists of providers.”
In
fact, many discharge planning teams at hospitals were not aware of the data or
information their system or used to determine which SNFs would make the cut for
their post-acute care networks, the authors noted. And the federal regulations
could contribute to staff feeling constrained in the information they could
provide, the authors told SNN.
“The
regulations are there to protect patient choice and avoid steerage of patients
for the financial benefits of the hospitals, but I think that there’s a varied
understanding in terms of what hospital staff is actually permitted and not
permitted to do,” Joan Guzik, director of quality improvement at the New York
City-based non-profit and co-author of the report, told SNN in January.
Transitions
of care have long been a headache for SNF providers, which receive financial penalties for
rehospitalizations of their patients over a 90-day period. And one major
nursing home trade group — the American Health Care Association — was
optimistic about the ramifications of the new rule, which it’s still reviewing.
“Any
change that improves the flow of information among providers and benefits
patients is a positive step,” Mike Cheek, senior vice president for
reimbursement policy at AHCA, said in a statement provided to SNN. “It is also
possible the final rule could help with clinical information SNFs need under
the Patient-Driven Payment Model (PDPM).”
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