Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. ACA Priorities for Care Coordination Depend on Electronic Exchange of Information

12/01/2011

The ACA of 2010 sets in motion changes to reform the United States health care system, improve the quality of care and control costs. Both health care delivery and payment structures are two ACA focal points. Specifically, ACA provisions aim to reduce care fragmentation by promoting delivery and payment improvements that support the continuity and quality of care as patients transition across care settings, reduce hospital readmissions, and curb unnecessary costs. Many ACA provisions seek to enhance collaboration among providers and promote mutual accountability by aligning incentives.10Table 1 highlights some of the ACA activities that advance the electronic information exchange and the use of HIT including EHRs by LTPAC providers.

TABLE 1. Key ACA Provisions that Impact LTPAC Providers
ACA
  Section  
Program
2701 Adult health quality measures for Medicaid eligible adults
2704 Evaluate integrated care around a hospitalization
3004 Quality reporting for long-term care hospitals, inpatient rehabilitation hospitals, and hospice programs
3006 Plans for value-based purchasing program for skilled nursing facilities and home health agencies including development, selection and modification of measures
3021 Establishment of Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services (CMS) (test and demonstrate new payment and delivery models)
3022 Medicare shared savings program (accountable care organizations)
3023 National pilot program on payment bundling and determination of the assessment instrument (such as Continuity Assessment Record and Evaluation (CARE)) to be used in the pilot program
3024 Independence at home demonstration program
3025 Hospital readmission reduction program
3026 Community-based care transitions program
3502 Community health teams to support the patient-centered medical home
6114 National demonstration projects on culture change and use of information technology in nursing homes
6703 Grant program for adoption and use of certified EHRs by LTCFs (e.g., nursing homes)
6703 Support participation of LTCFs and state HIE programs
6703 Secretary shall adopt and implement content and messaging standards for the exchange of clinical data by LTCFs

A number of ACA reforms extend across the health care continuum to stimulate coordination of care, especially after an acute episode. Service delivery and payment changes will encourage or require hospitals, physicians and post-acute care settings to work together to improve overall health care quality, reduce rehospitalizations and control health care spending.

LTPAC providers play a significant role in achieving ACA goals relating to care coordination and avoidable hospital readmissions because:

  • Over a third of all Medicare patients discharged from acute hospitals receive LTPAC services (almost 80 percent are either discharged to skilled nursing facilities or sent home with home health services).11

  • A significant portion -- almost one-quarter of Medicare beneficiaries -- discharged to a skilled nursing facility was readmitted to the hospital within 30 days.12

ACA Technology-Related Strategies to Improve Coordination and Reduce Rehospitalizations

  • Information exchange
  • Quality and outcome metrics
  • Improved communication
  • Payment bundling

Research is demonstrating that improved information sharing and coordination can impact hospital readmission rates.13 Accordingly, the ACA explicitly couples many reforms with the use of HIT and EHRs throughout the health care system, including LTPAC providers. A number of ACA provisions require, when feasible, the electronic exchange of patient clinical information. Other ACA sections mandate use of patient clinical data to measure quality and rely on or encourage the use of HIT to facilitate information sharing and improve care coordination and transitions in care. New Medicare and Medicaid payment methods will use electronic patient clinical data from many different provider types including: skilled nursing facilities, home health agencies, long-term care hospitals, IRFs, hospice and others.

These ACA provisions are expected to create market pressures on LTPAC to improve the quality, continuity, and efficiency of care; and the use of HIT and electronic HIE is expected to be a key enabler of these reforms.

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