Common Pay System on the Horizon for Post-Acute Care Providers?

It’s possible that the Centers for Medicare & Medicaid Services (CMS) will soon be implementing a common pay system for post-acute care providers, including skilled nursing facilities, home health agencies, long-term care hospitals and inpatient rehabilitation facilities.

Because similar patients can be treated in more than one provider setting, having a common evaluation and payment model and being able to “consistently measure patient acuity, resource use, and outcomes across settings will help to guide appropriate policies for these patient populations,” says the CMS report to Congress on the Post Acute Care Payment Reform Demonstration.

Currently, there are three mandated assessments for skilled nursing facilities, inpatient rehabilitation facilities, and home health agencies, but although they measure similar concepts, they use different clinical terms and assessment timeframes, and disparate measurement scales to assess health, physical function, and cognitive status, according to the report.


“The current Medicare payment methods for PAC providers are designed largely as independent systems that measure within-setting variation but they do not recognize the potential overlap in case mix or complementary service options available in other settings,” says CMS.

In trying to reform the current system, CMS developed a uniform assessment instrument called the Continuity Assessment Record and Evaluation (CARE) tool. The dataset for CARE includes Administrative Items; Pre-Morbidity Patient Information; Current Medical Information; Interview Items: Cognitive Status, Mood and Pain; Impairments; Functional Status; and Discharge Information.

Implementing this assessment within CMS’ demonstration was successful, the Center said, as all five settings were able to use CARE items “to collect information in a consistent and comprehensive manner for their Medicare populations.”


“Overall, the inter-rater reliability results showed very good agreement on most items,” the report says. “These results suggest that most of the standardized versions of the assessment items have strong reliability within and across settings.”

The report to Congress includes CMS’ demonstration results across the different post-acute care settings and lists recommendations for going forward with the payment system reform.

“Given the promise of the CARE tool and the importance of standardizing the collection of information between settings about patient acuity and outcomes, CMS believes that it should pursue its development efforts towards integrating CARE into the reporting requirements for acute care hospitals, SNFs, HHAs, IRFs, and LTCHs,” the report concludes.

View the full report here.

Written by Alyssa Gerace

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