While quality data is readily accessible on Medicare.gov, it's still unclear how exactly hospitals can make that information not only available.
A version of this article was first published December 16, 2020, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.
Q: Due to changes implemented by provisions of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act, hospitals must support the patient’s ability to choose a postacute facility by providing not only a list of providers in the patient’s area, but also information about the quality of services. What steps can hospitals take to provide clear, actionable information to patients?
A: For many organizations, compliance is a challenge.
While quality data is readily accessible on Medicare.gov, it’s still unclear how exactly hospitals can make that information not only available, but understandable so that patients and their caregivers can use it effectively to make decisions. Below are some strategies to help:
Participating in accountable care organizations (ACO). “Accountable care organizations have been leaders in utilizing high-quality, low-cost providers. ACOs are provider-led organizations that have a strong base in primary care and are accountable for quality and the cost of care across the continuum,” says Colleen Morley, DNP, RN, CCM, CMAC, CMCN, ACM-RN, president of CMSA Chicago.. “Because of this accountability, they create networks of preapproved postacute care providers for their members based on quality metrics.”
Establishing partner provider networks. Similarly, provider networks can be created in a less formal environment than an ACO. “This is an informal group of providers gathered by a central entity, usually a hospital, that are invited by the hospital to participate as part of the team providing continuing care services with a sharp eye towards quality,” says Morley. “Inclusion in these networks can be based on homegrown criteria, but always include the CMS quality data as the foundation.”
Ronald Hirsch, MD, FACP, CHCQM, CHRI, vice president with the Regulations and Education Group at R1 Physician Advisory Services in Chicago.cautions that CMS specifically forbids hospitals from designating any postacute provider as “preferred.”
“You can refer to them as ‘partners’ or place them at the top of the list of choices, but CMS considers the preferred designation as steering a patient when they want the patient to have full, uninfluenced choice,” he says.
Using technology. “Less formally, facilities can use software or databases’ help to access the CMS quality search engines at Medicare.gov to collaborate with the patient and the family members at the bedside in selection of postacute providers,” says Morley. Using technology eliminates the requirement to print out potential provider selections on a case-by-case basis from Medicare.gov. “Additionally, use of one of these software or database options can enable the patient or discharge planning professional to email other decision-makers directly from the portal with the information to be considered in choosing a postacute provider,” she says.
By strategizing carefully, hospitals can help meet this requirement and its intent—improving care for patients. “The ability as case management professionals to take a more active role in the discharge planning process with an eye to quality is in the best interests of our patients, taking the pre-2014 ’patient choice’ requirement to a new level of ‘informed patient choice’ through education and advocacy,” says Morley.
For more information on this topic, see December's issue of Case Management Monthly.
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