MDS Alert

Find out why you should care about the CARE.

Potentially coming to SNFs, home health, inpatient rehab facilities and long-term care hospitals: A single post-acute assessment tool that currently raises more questions than there are answers.

One thing for certain: The Centers for Medicare & Medicaid Services plans to use the Medicare Continuity Assessment Record and Evaluation (CARE) instrument in the Postacute Care Payment Reform Demonstration, which is scheduled to roll out in January 2008 and extend through 2009. The tool will measure the "health and functional status of Medicare acute discharges and measure changes in severity and other outcomes for postacute care patients," according to the CMS contractor for the project, RTI International. CMS' goal is to develop payment groups across post-acute settings.

Red-hot question: Could the CARE instrument replace the MDS? The American Health Care Association's Sandra Fitzler, RN, asked CMS folks that key question at a recent CMS-sponsored Open Door Forum. And " no one knows," says Fitzler, senior director of clinical services for AHCA. But "realistically, the instrument could replace the MDS in the future," says Peter Arbuthnot, regulatory industry analyst, American HealthTech Inc., in Jackson, MS. But CMS says that "for now, the form could be used concurrently with other forms." Nor has CMS "specified that the instrument would delay MDS 3.0." CMS hopes the demo will prove the CARE can be both a payment and quality tool, he adds. But the agency has made clear that the instrument would "probably not be the sole payment or quality tool in all postacute settings."

An Instrument of Different Feathers

The CARE instrument that CMS plans to use in the demonstration is a "hybrid combination" of forms ... including some MDS 3.0 items, says Arbuthnot. The assessment tool also includes data elements from the OASIS (home health assessment instrument) and the IRF-PAI (inpatient rehab facility patient assessment instrument).

For Medicaid too? CMS representatives speaking at the ODF said that right now the CARE instrument is "aimed at Medicare," Fitzler points out. But if facilities wanted to participate in the demo and include all of their patients, "CMS is willing to consider that," she says.

A Major Concern

CMS ultimately wants to be able to compare costs and outcomes for Medicare patients in various postacute settings. "It's always been important to the federal government to have that data for analysis to see which setting provided care" and whether the Medicare beneficiary got better or worse in a postacute setting, says Arbuthnot. "Everyone is very worried that CMS' effort to develop and use a universal instrument across postacute settings will result in a prescriptive assignment process for care."

Stay tuned: Of course, the demonstration testing the CARE instrument isn't the only postacute project on CMS' plate.

There is a new survey process, the MDS 3.0, the STRIVE project, etc., says Arbuthnot. The agency will be having "some big pow-wows in the next few months to see how its various projects and demonstrations will fit together," he relays.