What is the Impact Act? Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 is a bipartisan bill passed on September 18, 2014, and signed into law by President Obama on October 6, 2014.

Purposes of the IMPACT Act include:

•        Improvement of Medicare beneficiary outcomes
•        Provider access to longitudinal information to facilitate coordinated care
•        Enable comparable data and quality across PAC settings
•        Improve hospital discharge planning
•        Research

Who will be affected by the IMPACT Act?

Long-Term Care Hospital (LTCH)

Services provided: Inpatient services include rehabilitation, respiratory therapy, pain management, and head trauma treatment.

Inpatient Rehabilitation Facility (IRF)

Services provided: Intensive rehabilitation therapy including physical, occupational, and speech therapy.

Home Health Agency (HHA)

Services provided: Skilled nursing or therapy services provided to Medicare beneficiaries who are homebound.

Skilled Nursing Facilities (SNF)

Services provided: Short-term Skilled nursing and rehabilitation services to individuals whose health problems are too severe or complicated for home care or assisted living.

Why the attention on Post-Acute Care:

•        Escalating costs associated with Long Term Post-Acute Care (LTPAC)

o   Long-Term Care Hospital (LTCH) - Number of Facilities: 420, Average length of stay: 26 days, Number of Beneficiaries: 124k, Medicare spending: $5.5 billion.

o   Inpatient Rehabilitation Facility (IRF) - Number of Facilities: 1,166, Average length of stay: 13 days, Number of Beneficiaries: 373k, Medicare spending: $6.7 billion.

o   Home Health Agency (HHA) - Number of Facilities: 12,311, Number of Beneficiaries: 3.4 million, Medicare spending: $18 billion.

o   Skilled Nursing Facilities (SNF)- Number of facilities 15,000, Number of beneficiaries: 1.7 million, Medicare spending 6.7 billion

•        Lack of data standards/interoperability across PAC settings - this is why Section GG has been recently added to the MDS
•        Goal of establishing payment rates according to the individual characteristics of the patient, not the care setting

The IMPACT Act Requires Standardized Patient Assessment Data: This is the reason for the addition of section GG on the MDS. Section GG will allow for the standardization of questions as required for the calculation of Quality Measures across the care continuum. This standardization will include Inpatient Rehabilitation Facilities-Patient Assessment Instrument (IRF-PAI), Minimum Data Set (MDS), Outcome & Assessment Information Set (OASIS), and Continuity Assessment Record & Evaluation (LCDS). The goal of these changes is to improve discharge planning, increase the exchangeability of data, and improve the coordination of care.

The Quality Measure Domains and timelines are as follows:

DOMAIN NAME              ROLL OUT TIMELINE

Ready or not the IMPACT Act is here to stay. For additional provider-specific information please visit the Centers for Medicare & Medicaid Services website.