Opportunities for Engaging Long-Term and Post-Acute Care Providers in Health Information Exchange Activities: Exchanging Interoperable Patient Assessment Information. Federally Required Assessment Instruments

12/01/2011

As summarized in Table 2, CMS requires three LTPAC providers to complete and electronically transmit specific PAIs (i.e., records with clinical, demographic and other information about a patient). Providers and CMS use data from these instruments for payment, quality monitoring and reporting, patient assessment, and care planning. A fourth instrument is being demonstrated and evaluated.

TABLE 2. Existing Patient Assessment Instruments by Type of LTPAC Provider
  LTPAC Type     Patient Assessment Instrument  
Nursing Homes Minimum Data Set Version 3.0 (MDS 3.0)
Home Health Agencies Outcome and Assessment Information Set (OASIS)
Inpatient Rehabilitation Facilities Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI)  
Comprehensive assessment for post-acute care payment reform demonstration   Continuity Assessment Record and Evaluation (CARE) (demonstration)

The assessment instruments for nursing homes, home health agencies and IRFs are required by CMS to be completed on patients/individuals at various intervals of their stay. The instruments are required to be electronically transmitted each time they are completed in a format specified by CMS. As a result, almost 100 percent of these providers automate and transmit assessments, however, transmission formats are not interoperable (i.e., they do not adhere to accepted HIT formats and content standards) thus limiting the ability to exchange and re-use assessment content.

As part of a Deficit Reduction Act of 2005 demonstration on post-acute care payment reform, CMS developed the CARE instrument for use in this demonstration as a "single standardized patient assessment instrument…to measure functional status and other factors."14 In June 2011, CMS is required to report the demonstration results to Congress. The ACA also references the use of CARE or a similar instrument to support the national pilot program on payment bundling. Providers would use the instrument to evaluate a patient's condition and help determine the most appropriate care setting.15

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