What is the IMPACT Act of 2014?

The Improving Medicare Post-Acute Care Transformation Act" or the "IMPACT Act of 2014" was enacted by the Senate and House of Representatives in September 2014 and signed into law by President Obama in October 2014. The IMPACT Act of 2014 amends Title XVIII of the Social Security Act by adding a new section – Standardized Post-Acute Care (PAC) Assessment Data for Quality, Payment, and Discharge Planning. The ultimate goal of the IMPACT Act of 2014 is to reform post-acute care payments and reimbursement while ensuring continued beneficiary access to the most appropriate setting of care.

The IMPACT Act of 2014 requires submission and reporting of standardized specific clinical assessment and outcomes data by PACs = Home Health Agencies (HHA), Skilled Nursing Facilities (SNF), Inpatient Rehabilitation Facilities (IRF), and Long-Term Care Hospitals (LTCH). Hospice Care will also be subject to a standards survey by a state or local survey agency, or an approved accreditation agency.

Resources to Consider for Implementation of IMPACT in Practice Settings

Learning Modules

The IMPACT Taskforce under the direction of the Quality Management Committee developed two learning modules totaling 40 minutes. These are intended to educate practitioners on the IMPACT Act of 2014.

  • Module I will focus on an overall overview, RDN accountability, and EHR Standardized Assessment Data
  • Module II emphasizes the measure domains and nutrition care application

What is the Academy doing?

The IMPACT Act of 2014 timeline spans from 2017-2022 to implement the various segments and requirements. The Academy Quality Management Committee formed an IMPACT Taskforce with its charge to review the IMPACT Act of 2014 and its implementation process. The Taskforce charge includes providing guidance, communication via several Academy mediums, and practitioner deliverables which were released in January 2016, and Learning Modules in June 2016 to assist the RDN and NDTR with food, nutrition and dietetics services in Post-Acute Care settings.

The RDN Role

The RDN must be aware of the changes in the healthcare landscape, such as in the IMPACT Act, to remain a relevant and significant member of the health care team. RDNs must use their unique knowledge, skills, and abilities to play a significant role in improvement; that is, the healing time of pressure ulcers, changes in cognitive function, reducing hospital readmissions and eliminating major falls through evidenced-based research, nutrition specific interventions, education, coordination of care and monitoring and evaluation. In addition, the RDN can help post-acute care settings achieve positive clinical outcomes, quality measure improvement, cost savings, and provide an improved quality of life for the patient/resident.

It is important to monitor and evaluate interventions and adjust as needed. The RDN must be mindful of knowing when alternative methods of feeding may need to be considered, if consistent with the individual's advance/directives and goals of therapy. Or when appropriate palliative or hospice care must be considered. Education and interventions should be person-centered using the information obtained during the time in the post-acute care settings and may include adding fortified foods at each meal, easy to eat high calories snacks and supplements between meals, and fluids offered before and after each meal.

The RDN plays an essential role in discharge planning of patients/residents with a history of pressure ulcers or who are at high risk for developing pressure ulcers by utilizing patient/resident and family interventions and education. It is imperative that the RDN meet with patients/residents prior to discharge to ensure effective care coordination.

How does it relate to the Affordable Care Act?

The IMPACT Act of 2014 conveys the inclusion of patient-centeredness in its references and requirements related to capturing patient preferences and goals. It provides a tremendous opportunity to address all of the priorities within the Centers for Medicare & Medicaid Services (CMS) Quality Strategy, which is framed using the three broad aims of the National Quality Strategy:

  • Better Care: Improve the overall quality of care by making healthcare more patient-centered, reliable, accessible, and safe.
  • Healthy People, Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.
  • Affordable Care: Reduce the cost of quality healthcare for individuals, families, employers, and government.

The IMPACT Act of 2014 supports the three aims while upholding the CMS Quality Strategy's goals, which are:

  1. Making care safer by reducing harm caused in the delivery of care.
  2. Ensuring that each person and family is engaged as partners in their care.
  3. Promoting effective communication and coordination of care.
  4. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
  5. Working with communities to promote wide use of best practices to enable healthy living.
  6. Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new healthcare delivery models.

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