BriggsNetNews

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

The Lewin team, on behalf of the Centers for Medicare & Medicaid Services (CMS), seeks stakeholder comments on the following concept under development:

TITLE: Discharge from Inpatient Facilities to Home for Medicaid Participants

DESCRIPTION: This concept assesses the percentage of discharges of Medicaid participants 18 years and older from an inpatient facility (e.g., acute care hospital, long-term acute care hospital [LTAC], skilled nursing facility [SNF], inpatient rehabilitation facility [IRF]) to their home (e.g., assisted living, adult family home, group home).

NOTE: This document provides a draft description of the measure. We seek comments from the public about the draft measure concept and specific questions outlined in the Feedback section of this document. See the draft narrative for the concept below for more details.

MEASURE RATIONALE: Findings from an environmental scan/literature review suggest there is a measurement gap for assessing discharges to non-institutional settings for high-risk and high-need populations across Medicaid. The environmental scan results also emphasized the value of rebalancing efforts, which focus on ensuring that individuals and families avoid institutional settings and live out their lives at home. Additional findings suggested that discharges to home from inpatient/facility settings are associated with reduced inpatient facility readmissions, improved quality of life, and decreased health care expenditures. The proposed Discharge to Home concept is distinct from existing rebalancing measures, as its sole focus is on home discharge as a signal of quality.

MEASURE INTENT: The measure concept intends to assess rates of discharges for Medicaid participants from inpatient facilities to home-based settings. The concept is intended for use at the state level, with the goal of providing data to facilitate quality improvement and planning on HCBS placement of inpatient facility discharges. Implementation of the measure will facilitate monitoring of discharge trends, with the goal of increasing the rates of discharges to home, which increases the likelihood of improved quality of services provided and participant quality of life.

NEXT STEPS FOR MEASURE CONCEPT: Following the close of the public comment period, the Lewin team will review stakeholders’ comments and determine if revisions to the measure concept are needed. The Lewin team will then begin testing draft technical specifications for the concept, results of which will be published on CMS’s Blueprint for the Measures Management System (MMS) website at a future date.

FEEDBACK REQUESTED: The Lewin team, on behalf of CMS, is seeking feedback on all components of the measure, including the following topics:
• The potential importance, validity, feasibility, and usability of the Discharge to Home measure, which aims to assess and improve the quality of care for Medicaid participants.
• The potential measure exclusions.
• Options for the timeframe, post-discharge, to observe a discharge to home (i.e., a qualifying     numerator event). For example, a discharge to home without readmission to an acute or post-           acute care facility within 30, 60, 90, or another number of days of the discharge event.
• The availability of discharge data , particularly for dual eligible participants, and whether          collection of these data will present undue burden on states being measured.
• The potential unintended consequences of the measure’s focus and/or implementation.

Please be sure to review the Draft Measure Concept Narrative on pages 2 and 3 of this document and provide your specific comments.  LeadingAge provided comments last week on this proposed quality measure.