New CMS Rule Requires Hospitals To Provide Skilled Nursing Quality Data At Discharge

September 26, 2019, Maggie Flynn, Skilled Nursing News - The federal government issued a final rule on Thursday requiring hospitals to give patients access to more information about the post-acute provider choices available — including data on how their post-acute options perform on quality measures such as pressure ulcers, falls, and readmissions.

This new rule will not have any impact on anti-steering regulations that prevent hospitals from recommending specific skilled nursing facilities, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma stressed on a press call Thursday.

“This is really about making sure the patient has information about what happened, in the hospital,” Verma said on the call.  “And so when they do go to a post-acute provider, that they are able to have that information for the provider.”

The Medicare Payment Advisory Commission (MedPAC) sounded the alarm on the quality of the post-acute facilities patients where patients go after hospital stay last year in its March 2018 public meeting and in its report to Congress that same month.

“Medicare statute provides beneficiaries with the freedom to choose their PAC provider, and the laws state that hospitals may not recommend providers,” MedPAC senior analyst Evan Christman said in his presentation in the meeting.  “The IMPACT Act created a new requirement that hospitals use quality data during the discharge planning process and provide it to beneficiaries.  But regulations implementing this new requirement have not been finalized.”

That changed Thursday, with the final rule specifically implementing the requirements from the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act).  As a result, hospitals have to help patients, their representatives, and families by sharing data on quality measures for home health agencies (HHAs), SNFs, inpatient rehab facilities (IRFs), or long-term care hospitals (LTCHs) — in a way that’s relevant to patient goals of care and treatment preferences.

The new regulation will also boost interoperability by requiring that patients be able to access their medical records in the format of their choice, Verma said on the call.

“This requirement will ease communication between acute and post-acute care care providers,” she said.

Under the rule, the hospitals can’t specify or limit the qualified providers available to patients, and CMS emphasized that the anti-steering provisions affecting hospitals have not changed because of the final rule.

Those provisions have been a source of headaches when it comes to patient transfers.  Multiple reports have indicated that hospitals feel hamstrung by provisions of various laws guaranteeing freedom of choice to patients, at least when it comes to providing more information about the quality of post-acute providers in a given area.

One study in Health Affairs, published in August 2017, found that patients don’t receive quality-of-care data about SNFs when they are discharged from the hospital.  In most cases, in fact, people would receive lists of SNFs within their city with minimal information about the facilities.

Hospitals might not have been aware that they could help patients in choosing better-quality facilities without restricting their choice, author Denise Tyler told Skilled Nursing News at the time.

“The statute simply says people should not be restricted in their providers,” she said.  “A hospital that gives a list of facilities but points out which ones are vetted and of superior quality is still a choice, but a more informed choice.”

The United Hospital Fund also called out the confusion over legal mandates in a November 2018 report on care transitions to post-acute care.  The group noted that federal regulations allow hospitals to refer patients to resources such as Nursing Home Compare or official state websites for information about post-acute providers, as well as permitting hospitals to help patients interpret quality-related information.  However, that regulation does not specifically require acute care providers to do so.

“This distinction between permitting and requiring the provision of information about PAC providers can get lost on the ground, when hospitals concerned about compliance may err on the side of legal caution,” the UHF noted in its report.  “Narrow interpretation of the regulations has led many discharge planners on the frontlines to be cautious about providing much assistance or advice to patients and families beyond distributing lists of providers.”

In fact, many discharge planning teams at hospitals were not aware of the data or information their system or used to determine which SNFs would make the cut for their post-acute care networks, the authors noted.  And the federal regulations could contribute to staff feeling constrained in the information they could provide, the authors told SNN.

“The regulations are there to protect patient choice and avoid steerage of patients for the financial benefits of the hospitals, but I think that there’s a varied understanding in terms of what hospital staff is actually permitted and not permitted to do,” Joan Guzik, director of quality improvement at the New York City-based non-profit and co-author of the report, told SNN in January.

Transitions of care have long been a headache for SNF providers, which receive financial penalties for rehospitalizations of their patients over a 90-day period.  And one major nursing home trade group — the American Health Care Association — was optimistic about the ramifications of the new rule, which it’s still reviewing.

“Any change that improves the flow of information among providers and benefits patients is a positive step,” Mike Cheek, senior vice president for reimbursement policy at AHCA, said in a statement provided to SNN.  “It is also possible the final rule could help with clinical information SNFs need under the Patient-Driven Payment Model (PDPM).”