Gaps Remain in Post-Acute and Long-Term Care Performance Measures

Gaps remain in performance measures for post-acute care (PAC) and long-term care (LTC), particularly with regard to care coordination and information exchanges, according to a report from the non-partisan National Quality Forum’s (NQF) Measure Applications Partnership (MAP).

Though performance measures are key for payment reform and sparking quality improvements, PAC and LTC settings have differing standards, leading to fragmentation, the NQF said.

Care coordination is particularly important in those settings, and some providers have already begun to take steps to track patients after they’re discharged from a skilled nursing facility.


But in terms of the Centers for Medicare & Medicaid Services’ (CMS) Meaningful Measures framework, “critical” gaps in the performance measures remain.

“In particular, MAP emphasized the importance of care coordination in post-acute and long-term care as patients may frequently transition between sites of care,” the report said. “MAP recommended that measure developers focus on care coordination measures.”

The specific care coordination measures included the timeliness of information transfer, the electronic exchange of clinical information, advanced care planning, and bidirectional information exchange measures, which would note if information was sent and received — and if the receiving provider had followup questions.


Patient-reported measures

The MAP also examined the CoreQ: Short Stay Discharge Measure, which is under consideration for the SNF Quality Reporting Program (QRP) established under the 2014 Improving Medicare Post-Acute Care Transformation Act (IMPACT). SNFs that do not submit the required data will face a 2% reduction in yearly payment rates, the report noted.  

The discharge measure calculates the percentage of short-stay SNF residents who are satisfied upon release from the facility. Resident satisfaction was previously identified by MAP as a gap area for the SNF QRP, and the short-stay measure could more accurately gauge care quality from the patient perspective.

MAP supported the Short Stay Discharge Measure for rule-making. The lone public comment MAP received on its recommendation of the short-stay measure was positive, but asked CMS to consider the possible burden of implementing the measure — which could include the costs of using a proprietary tool and the challenges of gathering patient-reported data.

MAP, in turn, said implementing a new data collection mandate should be done with the least possible burden to facilities, but added that CMS should implement the measure in a way that allows for inclusion of as many residents as possible.

Written by Maggie Flynn

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