The Medicare post-acute care payment reform initiative: impact and opportunity for case management.

PURPOSE/
OBJECTIVES: The Deficit Reduction Act of 2005 mandated that a standardized patient assessment occurs for all Medicare recipients at hospital discharge (regardless of whether they are transferred to a post-acute care [PAC] setting) and during stays in PAC settings to support PAC payment reform. The purpose of this article is to describe the current progress on this initiative and the impact and opportunities it presents for case managers. PRIMARY PRACTICE SETTINGS: The mandate applies to acute care hospitals, skilled nursing and inpatient rehabilitation facilities (IRFs), home health (HHA), and long-term care hospitals. FINDINGS/
CONCLUSIONS: The PAC payment reform demonstration project is under way. The same standardized assessment tool will be utilized to measure the patient's health and functional progress throughout the entire episode of care. A Web application for providers to submit the assessment data to Center for Medicare and Medicaid Services is also under development. A final report must be submitted in Congress in 2011. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: 1. An assessment of a patient's discharge health and functional status will be available to the healthcare team to determine appropriate placement into a PAC site. 2. A patient's health and functional progress will be monitored throughout an episode of care. 3. Case managers have long known that paying attention to patients' needs across the care continuum can impact the outcomes of the care provided. 4. You can impact this initiative by discussing the opportunity to participate in the effort with other members of your organization and/or providing information on patient characteristics important to the discharge/transfer decision to the study team.