A CMS rush puts long term rehabilitation care at risk
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The U.S. Department of Health & Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) do not work well under aggressive deadlines. From the flawed rollout of the HealthCare.gov website to recent payment model pilot programs failing to reduce program costs, these agencies often implement programs without evidence they will work as intended. This leads to expensive changes to get them to work correctly.

Now we have new evidence of this.

CMS recently rolled out a new set of quality measures required under the IMPACT Act, a bill signed into law in 2014.


The goals of the IMPACT Act were twofold.

The first was to create standardized patient assessment data to support a new series of quality indicators for post-acute care providers to better measure the quality of care. These new tools would impact long-term care hospitals, inpatient rehabilitation facilities, skilled nursing facilities and home health providers.

The second goal was to examine the potential of creating a single post-acute care payment system. Maintaining different systems and rules for each post-acute care venue has caused Medicare program costs to steadily increase without significant improvements to the quality of care.

Additionally, since each post-acute care setting collects its own data, it is impossible to determine at what cost similar patients receive similar levels of care. The Act was a legitimate attempt by Congress to control costs and pay healthcare providers a standardized amount for similar patients.

But once it became time for CMS to write IMPACT Act regulations creating the quality indicators and payment system, the wheels began to fall off.

CMS fast-tracked the regulations through the process over the past two years over objections from the industry. When challenged, the agency pointed to the aggressive dates required by IMPACT Act as justification.

There are several objections to the CMS regulations.

First, and foremost, the CMS regulations would actually increase the cost of care. This is the exact opposite of one of Congress' key goals for the Act.

According to UDSmr’s analysis, the new regulations raise staff education costs and require a significant amount of time and money for administrative tasks, such as updating forms. They also require each patient to undergo an extra series of assessments.

These costs add up quickly. For some providers, it could add several hundred thousand or millions of dollars to operating costs. Because CMS has not increased payments to accommodate the additional expenses, the increase in costs could lead to the decision to close a wing or even shut down a facility and restricting access to care.

A second problem that our review shows is that it will require at least an additional 75-90 minutes per patient to report the new data elements. This is especially troublesome when you consider that some of these new items are duplicative, minor adjustments to items already collected. More time spent on administrative red tape means less time spent providing patient care.

Another problem is that they are not standardized across all post-acute care sites. CMS’ regulations include all sorts of inclusions and exclusions, depending on the type of site performing the rehabilitation. Dozens of facility-specific factors further complicate matters. This is all contrary to the explicit language in the Impact Act.

Finally, most the quality measures have neither been fully tested nor have they been found to either control costs or improve quality. They have not received final approval or endorsement from any review panel, such as the National Quality Forum, indicating they are ready for implementation. CMS claims that these measures were "approved pending changes", but no one other than CMS has reviewed or has an opportunity to comment on changes prior to implementation.

In short, the regulations were not ready for use on October 1, and there are no quick fixes.

As a result, assuming he is confirmed, Dr. Tom Price, President-elect Trump’s nominee to be the new Secretary of Health and Human Services, should use his authority provided in the IMPACT Act to suspend implementation of these quality measures until CMS has solved the many identified, significant flaws.

To do any less would be a step back in patient care for thousands of Americans, and continue the trend of unnecessary increases in costs to the Medicare program.

Kathy Dann is the Chief Operating Officer of the Uniform Data System for Medical Rehabilitation (UDSmr), a not-for-profit Buffalo-based medical rehabilitation technology and research firm affiliated with the University at Buffalo. 

The views expressed by contributors are their own and not the views of The Hill.