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First, we examined the proportion of HAC and matched non-HAC episodes with all-cause 90-day readmissions and the proportions with inpatient PAC transfers, including LTCH, SNF, IRF, and IPF claims.
Recognizing the importance of ACP within the LTCH setting, especially for persons with dementia, it is essential to review what programs have been used in LTCHs to promote ACP.
Recommendation: In order to improve the data available on the quality of care at LTCHs, the Administrator of CMS should improve the accuracy of the databases that track LTCH survey results by (1) working with AOs and state survey agencies to develop a complete and accurate list of the LTCHs that they each survey and an approach to ensuring that the list is updated in a timely manner, and (2) expanding the On-line Survey, Certification, and Reporting system (OSCAR) database to include the results of all LTCH surveys, such as those conducted by TJC, which are currently stored in the separate Accrediting Organization System for Storing User Recorded Experiences (ASSURE) database.
MEDPAR discharge data for LTCHs are examined for Medicare fee-for-service beneficiaries who were discharged during CY 2004 with a procedure code of 96.72 (continuous mechanical ventilation for 96 consecutive hours or more) to avoid early onset infections that may have begun prior to the LTCH admission (N=13,759).
To determine the PAC bundled payments, all SNF, IRF, LTCH, HHA, carrier, and acute readmission amounts were aggregated for the 90-day postdischarge period.
The prospective payment systems for acute hospital care, LTCH, SNF, IRF, and HHA each have separate rules for payment, eligibility, coverage, and performance measurement.
NALTH also objected to a proposal from CMS to impose a one-time 3.75% reduction at the end of a three-year period ending December 29, 2010, arguing that LTCH payments and costs have already been aligned for budget neutrality purposes as required by law.
We supplemented the Medicare timeline file with Medicaid waiver coverage information using the MAX personal summary file, and determined which inpatient care occurred in an inpatient psychiatric facility (IPF), inpatient rehabilitation facility (IRF), or long-term care hospital (LTCH) using the Medicare Part A claims file.
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