Much headway has been made in the six months since the Improving Medicare Post-Acute Care Transformation (IMPACT) Act became law, report representatives from the Centers for Medicare & Medicaid Services (CMS) this week at the 2015 Long-Term and Post-Acute Care (LTPAC) Health IT Summit in Baltimore.
The bipartisan law will standardize quality assessments for critical care issues across the spectrum of post-acute care providers such as long term care hospitals, skilled nursing centers, home health agencies, and inpatient rehabilitation facilities. These streamlined measures will facilitate the comparison of outcomes across these four PAC settings, allow for interoperability, and enable coordinated longitudinal care for Medicare patients.
“There has been a monumental crossing of bridges to bring together years of work,” said Stacy Mandl, RN, BSN, BSW, PHN, deputy division director, Division of Chronic and Post-Acute Care (DCPAC), CMS.
The current state of health care can be likened to a hospital that uses different assessment data tools for each unit—a nurse trying to receive patients cannot simply communicate through electronic health records, said Mandl. She elaborated that because communication among providers is not standardized, providers often double- and triple-document survey data, which comes at great time and staff expense.

“The IMPACT Act has very aggressive timelines,” said Mandl. All four PAC settings must have  the required measures in place according to provider type and measure domain type, with the earliest of such specified dates being  Oct. 1, 2016. All four settings must report standardized data using the assessment instruments  on at least five of the following eight quality measure domains: functional status, cognitive function, changes in function and cognitive function, skin integrity and changes in skin integrity, medication reconciliation, incidence of major falls, and communicating the existence of and providing for the transfer of health information and care preferences.  Standardized data in patient assessment domains are also required, and Long-term Care Hospitals, Inpatient Rehabilitation Facilities and Skilled Nursing Facilities  are required to being reporting such assessment domain data standardized data to CMS starting Oct. 1, 2018, and for Home Health Agencies, January 1, 2019.

“Measures must be standardized across all four settings,” says Tara McMullen, MPH, PhD, with the CMS Quality Measures & Health Assessment Group. “We’re trying to get the ‘sweet spot’ of where all the data analyses for all four settings converge.”
ina Gonzaga, MSN, RN, detailed the data standardization process. Reusable templates for clinical and quality data are being created such that the headers of the documents remain consistent but the bodies of the texts are more dynamic.
Additionally, CMS is creating an assessment data library for the public. It will house the assessment data that are currently collected via various mechanisms: CARE tool, OASIS, MDS, LCDS, and IRF-PAI.
Jennie Harvell, MEd, who is interning at CMS’ DCPAC, said that the library will be implemented in phases, with the first phase to come this fall.
Jackie Oberst is Provider’s managing editor. Email her at or follow her on Twitter, @Prov