CMS HIT for Care Transitions CARE, MDS, OASIS

Transcription

1 CMS HIT for Care Transitions CARE, MDS, OASIS NQF Care Coordination Meeting March 27, 2008 Joanne Lynn, MD, MA, MS Division of Chronic and Post-Acute Care Quality Measures and Health Assessment Group Office of Clinical Standards and Quality Centers for Medicare & Medicaid Services

2 Usual Clinical Practices Average transition from hospital includes a medication error Average Medicare patient living with serious chronic conditions has no integrated record The patient sees a dozen physicians and uses multiple settings of care each year No feedback to clinicians on quality of transitions

3 Trustworthy Practice Plan of care exists, including time frame Plan reflects clinical situation and likely course Plan reflects patient and family preferences and capabilities Transitions curtailed as possible Transitions incur no errors

4 What counts in transitions Continuity of plan of care goals, settled decisions, understanding of clinical situation Continuity of treatments medications, therapies, supportive services Continuity of relationships it is always about the people

5 What helps Trustworthy Transitions? Negotiated understanding of roles, language, capabilities among providers Honesty with patients and families about options and outcomes, negotiated plan of care Reliable transfer of comprehensive and efficient records Person-to-person communication Overlapping responsibility (no hand-offs ) Feedback loops reporting performance

6 Could CMS HIT help? Documentation of key aspects of patient s situation, plans, and treatments Available in real time across settings Evaluate transition performance in aggregate Provide feedback on individual patients and transitions

7 Current CMS Activities Event-driven patient assessments MDS for nursing homes OASIS for home care agencies IRF-PAI for inptt rehab facilities Information reported on claims G codes Hospital-acquired, present on admit Direct and indirect data reporting ESRD Registries

8 Example: the Minimum Data Set Congressionally-mandated for nursing home residents admit, discharge, interim, events Covers health status, function, treatments Generates quality indicators for facilities Generates quality measures for public reporting on Nursing Home Compare Provides data for payment Contributes to care planning for residents

9 Data Path for MDS Interdisciplinary team at nursing home generates the data Submits data to state servers Edits and uses by states Transmit to CMS CMS edits and corrections, payment uses, quality indicators, quarterly updates to Nursing Home Compare Program monitoring and research uses

10 Uses QMS Public Reporting Medicare Medicaid Payment (Some States) MDS Care Planning Quality Improvement Survey Quality Indicators

11 MDS Developments New version for October 2009 Better data Resident survey items Better items, scales More efficient Deliberately more aligned with OASIS

12 Patient Assessment Problems with MDS, OASIS & IRF-PAI: Incompatible data formats Different data storage sites Different measurement scales and items Different assessment periods No data from hospitals Built-in delays in processing No display for clinician use Thus, not useful for clinical excellence

13 Continuity Assessment Record and Evaluation (CARE) Aims Clinically useful real-time, cross setting Including hospitals Quality measurement Payment Under development First use in payment demonstration now Upcoming use in quality improvement (with QIOs in 9 th SOW)

14 CARE, to date Data collection items Best from existing instruments Some new elements Internet platform Secure access for institutional providers Downstream provider can view in real time Adhering to IT best practices E.g., LOINC, HL-7, RxNorm, etc.

15 CARE, on the horizon. Upload and download, standards for interoperability Carry forward Displays customized for various uses Data elements on the fly rather than on the paper form More flexible storage Physician access and input

16 CARE a little farther out Broader use to report data for quality measurement Beneficiary able to monitor use or perhaps see findings Interact with regional data storage and exchange Methods to continually improve data elements and presentation

17 Summary Moving from one setting or clinical team to another is high-risk for our high-risk Medicare beneficiaries CARE offers a number of solutions CARE will require a few years of development before the decision about broad deployment Advice and assistance welcome!

18 For more information: Judy Tobin, PT, MBA Project Officer, And Joanne Lynn, MD, MA, MS Medical Officer Office of Clinical Standards and Quality Quality Measures and Health Assessment Group Division of Chronic and Post-Acute Care, CMS