President Signs IMPACT and Issues Executive Order on Five-Star

Karen Morris in Clinical & Quality

The following is a memo from Mark Parkinson, president and chief executive officer of the American Health Care Association and the National Center for Assisted Living.

Today, I was in the Oval Office to attend President Obama’s signing into law the Improving Medicare Post-Acute Care Transformation Act (IMPACT) of 2014. IMPACT sets the stage for a site neutral payment system and supports AHCA’s Quality Initiative. This law has four components:

  1. The incorporation and use of standard assessment tools across all post-acute settings (i.e., IRFs, LTCH, SNFs, and Home Health).

  2. Public reporting of a set of quality measures related to post-acute care, many of which align with AHCA’s Quality Initiative, such as rehospitalizations, staff turnover and customer satisfaction.

  3. Funding to support CMS’s use of payroll data to evaluate staffing.

  4. Reports from HHS and MedPAC on how to better measure quality and reform payments in post-acute care settings.

The President also issued an Executive Order to make changes to the CMS Five- Star Quality Rating System. As you know, historically we have not supported Five-Star. Although we continue to have concerns and criticisms about the program, it has helped our members to improve their ratings over time.

The President’s Executive Order directs CMS to:

  • Implement auditing of MDS data among a sample of centers in each state starting in January 2015;
  • Use payroll data to validate staffing information and report turnover and retention;

  • Adjust the scoring methodology by giving higher weight to quality and staffing measures that independent sources have verified;

  • Ensure the survey inspections in each state are completed in a more timely manner; and

  • Add additional quality measures to Five-Star, specifically rehospitalizations, discharge back to community and antipsychotic use.

Most of these recommendations align with AHCA’s current position that quality measures and staffing information should be accurate and consistent with IMPACT or other existing laws. The Executive Order also indicates a greater recognition of the importance of our Quality Initiative’s four goals (reduce rehospitalizations, reduce antipsychotics, decrease staff turnover and increase customer satisfaction) and the significant progress our membership has made in these areas.

We will work with the Administration and CMS staff to ensure the Executive Order is implemented in a manner that is fair to our members. We will keep you informed as we learn more on how these changes will impact you. The Board has made it very clear that we oppose any change in Five Star that arbitrarily lowers members’ ratings. The devil is in the details of implementation and we will continue to fight on your behalf.

Mark Parkinson

Karen Morris

Director, Clinical & Quality Services
518-462-4800, ext. 15