A significant issue affecting the quality of transitions between hospitals and post-acute care settings is the interoperability of electronic health records (EHR). The exchange of accurate and timely health information on a patient’s diagnosis, care plan, and medications is crucial for a patient’s safe transition to and from post-acute care. This process can be complicated by utilization of different EHR systems by hospitals and post-acute providers, which make them incompatible for exchanging health information about the patient. In addition, these EHRs often do not allow for two-way communication between providers.
WHA’s Post-Acute Work Group welcomed Joe Kachelski, CEO of the Wisconsin State Health Information Network (WISHIN), and Ben Marquardt, Growth Director at PatientPing, to its April 19 meeting for a discussion of tools to facilitate patient care coordination and sharing of real-time patient information during care transitions.
Sharing Patient Information in Real Time
WISHIN’s Patient Pulse allows health care entities connected through WISHIN to share patient health care information in real time. When information is entered into the patient health care record, it is immediately available to providers within WISHIN.
- This has the potential to streamline the transition process for patients who move from one care setting to another, such as from hospital to nursing home.
- Pulse sends admission, discharge and transfer data to PatientPing, which is a secure network. “Pings” are then sent to health care organizations participating in WISHIN that have a relationship with the patient.
- These notifications facilitate care coordination by letting providers know, in real time, when and where one of their patients is being seen.
The Work Group also heard from Lisa Kirker, Lynne Willer and Angella Mattheis of SSM Health at Home, who highlighted issues that affect post-acute care provided by home health agencies, as well as durable medical equipment providers. Kirker pointed out that home health care provider agencies have not seen a Medicaid rate increase for over 10 years and operate at a loss when providing skilled nursing visits in the home.
Changes in Medicare and Medicaid reimbursement for durable medical equipment (DME) over the past several years have led to significant shortages of DME suppliers in Wisconsin, as well as reimbursement rates that are in some cases below the cost of providing the equipment and supplies. Mattheis described some of the most serious issues, including federal reimbursement rate cuts for oxygen and supplies that have resulted in a severe lack of access for DME oxygen in Wisconsin. The federal 21st Century Cures Act requires states to limit Medicaid funding for certain DME based on the lowest Medicare maximum fee rates in each state.
Mattheis reported that providers have banded together as the Midwest Association for Medical Equipment Services and Supplies (MAMES) to work with Wisconsin Medicaid to achieve a phase-in of this rate cut. Wisconsin’s Medicaid program will gradually reduce maximum fees over four calendar years for five HCPCS codes for oxygen and related supplies, rather than implementing the rate cut all at once. Effective January 1, 2019, Wisconsin Medicaid will annually reduce the rate for each code by 25% of the difference between the current Medicaid maximum fee and the lowest corresponding Medicare maximum fee until the full rate reduction is reached. MAMES is continuing to work with Wisconsin Medicaid for additional modifications to the DME fee schedule to improve access for patients to essential supplies and equipment.
CNA Training Hours
Kirker also initiated a discussion about a bill currently before the Wisconsin Legislature that would decrease the required number of training hours for certified nursing assistants from 120 hours to 75 hours (the federal minimum).
The Work Group’s reactions to this proposal were mixed; the nursing home administrators on the Work Group tended to favor this proposal, while other members did not support it. There was an acknowledgement by all that if the training hours were reduced, the CNA’s employer would have to provide additional on-the-job training to adequately prepare the CNA.
Kirker also highlighted proposed legislation that expands reimbursement for telemedicine under Medicaid. This legislation is being advanced by WHA and would allow reimbursement for more services and in more settings, including in the patient’s home.
The Post-Acute Care Work Group will meet again this summer. For further information on the Work Group, contact WHA Vice President of Policy Development Laura Rose