The CMS is preparing to test its new Continuity Assessment Record and Evaluation tool, which will determine post-acute Medicare payouts, in a three-year demonstration beginning in 2008.
Unlike tools the CMS now uses to gauge Medicare paymentIRF-PAI, MDS and OASIS, which are incompatible with one another and have different measurement scalesthe CARE tool is based on standardized data formats that can be submitted through a Web-based application while incorporating the existing clinical workflow, said Michael Rapp, director of the Quality Measures and Health Assessment Group at the CMS. Rapp gave an update on the project during a Dec. 14 quality work group meeting of the American Health Information Community.
The CMS is selecting 10 to 15 markets representing at least 150 providers across a range of healthcare facilities in which to conduct the demonstration, he said.
The tool will first be used to measure treatment and outcomes of patients in post-acute-care settings. The CMS will study the patient assessments submitted while determining how these assessments vary across providers nationwide. Four domainscognitive impairments, medical, functional and social/environmental factorsmake up the framework in which the CMS will assess case-mix severity, according to a CMS white paper outlining the project. The CARE tool gives the federal agency and providers better information on the severity of each patients case, the CMS said.
Ultimately, the CMS hopes to replace its three incompatible data assessment tools with CARE. The tool is a potential vehicle for healthcare providers to easily access standardized patient data while incorporating changes in evidence-based medicine, Rapp said. "We're pretty excited about it," he said.
Starting in January in the demonstration markets, the CARE tool will collect admissions and discharge data for Medicare beneficiaries in addition to cost and resource use data in two-week increments. Providers can submit reports directly to the CMS via the Internet; eventually, the CMS hopes to develop an interoperable system that will allow physicians to upload stored patient information, such as insurance data, to reduce data-entry time, according to the federal agency.
The American Hospital Association, responding to a call for comments on the CARE project, in September wrote that the tool has the potential to streamline hospital discharge planning, but that general acute-care hospitals would feel "a huge resource burden" because of the cost and time required to conduct reporting.
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