A Common Assessment Tool for Post- Acute Care

Traditionally Post-Acute Services like Home Care, In-Patient Rehabilitation Hospitals, Skilled Nursing Facilities, and Long Term Care Hospitals have resided in individual silos. Despite the fact that they are utilized, largely, post hospitalization, they have not had any common data sets, no uniform initial assessment tools, no common pricing components, and differing methodologies for assessing quality outcomes. The net effect of this is persons requiring post- acute services at discharge may find themselves discharged to different silos notwithstanding a similar acuity level. For example, two individuals discharged from the hospital for say, a lesser acuity stroke, may find themselves in totally different environments post hospitalization; one individual may be discharged to a skilled nursing facility while another may be discharged into home health with the entirety of the process being driven by individual treatment protocols of the discharging facility or treating physicians usual and customary practices.     

Now it’s certainly to be noted that exceptional care and outcomes can be driven from all of these discharge venues and that there are individual considerations that can make one or the other more appropriate a destination for any one of two individuals of similar acuity. That said there are tremendous benefits for patients and improved cost to the public health system in ensuring that these discharges are driven by patient specific characteristics and not simply historical treatment patterns, preferences and relationships.

Interestingly, the Medicare Payment Advisory Commission (MedPac), a 17- member Commission established by the Balanced Budget Act of 1997 to advise Congress on issues affecting Medicare payments to private health plans and providers, is beginning to turn their attention to the matter of post- acute services discharge. In its annual March report to congress, among many other recommendation, MedPac will recommended that Congress ask HHS (Health and Human Services) to implement a common assessment protocol for home health agencies, skilled-nursing facilities, inpatient rehabilitation hospitals and long-term care hospitals. The proposal is intended to facilitate comparisons of patient outcomes and costs across post-acute care settings. This is significant as it represents a first step toward moving to a post- acute discharge methodology that will be determined via specific patient assessment for best point of destination post hospitalization. It represents the basis for building a discharge process rooted in risk adjusted data that can serve as a foundation for developing best practices for the post- acute discharge process.

To the extent that patients want and the public health system benefits from the discharge of hospitalized patients into the least restrictive and lowest cost venue of care most able to meet their rehabilitative needs, home health care stands to benefit from this type of policy implementation. For patients with a home environment supportive of their return to it for rehabilitation, with assistance where necessary with ADL’s (Activities of Daily Living), making a singular transfer from the in-patient setting directly to home just makes more sense. The fewer steps or the shorter the step down from the in-patient to the home setting the more likely the care transition process is to be successful and the less likely the patient will find themselves re-hospitalized. From Medicare’s perspective it also creates an environment to lower overall post- acute care expenditures.

Home Health generally, and Pyramid Home Health Services specifically is highly focused on demonstrating its value to the healthcare continuum as the optimum manager of the care transitions process. Medicare policy changes that result in all patients indicating a need for post- acute care services receiving a standardized post-acute assessment will serve to increase the utilization of home health initially post discharge; both due to home health’s capabilities to serve as the patient’s least costly primary location for rehabilitation but also because of the greater level of coordination it brings to the overall transition to home process. In the post ACA (Affordable Care Act) environment where the concepts of global capitation with gain share put intermediaries and hospitals simultaneously at greater financial risk for and eligible to receive greater financial rewards relating to outcomes, these two  attributes, found in well organized and efficacious home health services, bode well for its longer term success.  In the final analysis, home is where the patient wants to be and its where the American Health System has to get them back to as expeditiously as possible when cost considerations come into play.


If we at Pyramid Home Health Services can assist you, your family, practice or beneficiaries with rehabilitation at home, visit us at www.pyramidhhs.com or call us at 888-880-6565.

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