Early Findings for Standardized Post-Acute Data Elements

Members | December 05, 2018 | by Aaron Tripp

RAND Healthcare and the Centers for Medicare and Medicaid Services (CMS) recently presented early findings from the national beta test of candidates for the Standardized Patient Assessment Data Elements (SPADEs).

This is ongoing work from the IMPACT Act of 2014 which requires standardized patient assessment data across post-acute care (PAC) settings to enable:

  • Improvements in quality of care and outcomes,
  • Comparisons of quality across PAC settings,
  • Information exchange across PAC settings,
  • Enhanced care transitions and coordinated care, and
  • Person-centered and goals-driven care planning and discharge planning.

This work crosses home health agencies (HHA), inpatient rehabilitation facilities (IRF), long-term care hospitals (LTCH), and skilled nursing facilities (SNF). The categories identified for standardization include:

  • Function (e.g., self care and mobility)
  • Cognitive function (e.g., express and understand ideas, mental status, such as depression and dementia)
  • Special services, treatments, and interventions (e.g., need for ventilator, dialysis, chemotherapy, and total parenteral nutrition)
  • Medical conditions and co-morbidities (e.g., diabetes, heart failure, and pressure ulcers)
  • Impairments (e.g., incontinence, impaired ability to hear, see, or swallow)
  • Other categories

To the extent possible, elements were gleaned from the intersection of the existing assessment instruments for each setting, the MDS 3.0, OASIS-C, IRF-PAI and LTCH CARE Data Set. From there the guiding principles for evaluation of the elements were for:

  1. Potential for improving quality
  2. Validity and reliability
  3. Feasibility for use in PAC
  4. Utility for describing case mix

The national beta testing occurred between November 2017 and September 2018 in 14 markets. Of the sample of 149 providers across the 4 categories, nonprofit organizations made up 49% of the sample. The presentation detailing the design and results for each item is available. Additionally, the admission, discharge, and non-communicative protocols have been made publicly available describing the items and process from the national field test.

This is a project that LeadingAge is monitoring to alert members about potential future changes. It could be important as CMS works towards a unified PAC prospective payment system. Comments are being collected by RAND based on the results of the beta test and can be directed to spadeforum@rand.org. Those comments received by the close of business on January 15, 2019 will be officially reviewed and summarized. If you have feedback we ask that you share with Aaron Tripp, Vice President, Reimbursement and Financing Policy, as well.