What is the IMPACT Act of 2014?
The Improving Medicare Post-Acute Care Transformation Act (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 and improving the care delivered. The IMPACT Act of 2014 effects nutrition care as the standardized patient assessment data include malnutrition-related quality measure domains.
The IMPACT Act of 2014 requires submission and reporting of standardized specific clinical assessment and outcomes data by PACs. Below are a list of care settings and the associated CMS assessment instruments
- Inpatient Rehabilitation Facilities (IRFs): IRF Patient Assessment Instrument (IRF-PAI)
- Home Health Agencies (HHAs): Outcome and Assessment Information Set (OASIS)
- Long-Term Care Hospitals (LTCHs): LTCH Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS)
- Skilled Nursing Facilities (SNFs): Minimum Data Set (MDS)
- Hospice Care: Hospice Item Set (HIS) and, coming soon, Hospice Outcomes and Patient Evaluation (HOPE)
- Home and Community-Based Services (HCBS): Functional Assessment Standardized Items (FASI)
What is New with the IMPACT Act of 2014?
It is incumbent on RDNs to monitor regulations that are applicable to their role, such as in the IMPACT Act, to remain a relevant and significant member of the health care team. Registered dietitian nutritionists must use their unique knowledge, skills, and abilities to play a signification role in improvement in healing time of pressure ulcers and cognitive function, reducing hospital readmissions, and eliminating major falls.
Registered dietitian nutritionists achieve this through evidence-based research, nutrition specific interventions, patient/client/resident/caregiver and interprofessional team 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/client.
Resources to Consider for Implementation of IMPACT in Practice Settings
The IMPACT Act of 2014 improves the care delivered to malnourished patients by including malnutrition-related quality measures in the standardized patient assessment data. The below are nutrition related clinical case studies and measure domains created by volunteer practitioners in 2016 and reviewed for clinical currency in 2022 on the quality measure domains.
- Fact Sheet: RDNs Making an IMPACT
- Case Study/Measure Domain: Skin Integrity and Changes in Skin Integrity
- Case Study/Measure Domain: Functional Status, Cognitive Function, and Changes in Function and Cognitive Function
- Case Study/Measure Domain: Incidence of Major Falls
- Case Study/Measure Domain: All-condition Risk-adjusted Potentially Preventable Hospital Readmissions Rates
In addition to Academy created resources, CMS maintains the Data Element Library. The DEL is a centralized resource for CMS assessment instrument data elements (e.g., questions and responses) and their associated health information technology.
The purpose of the DEL is to promote interoperable health information exchange, support "Patients over Paperwork" and assist with standardization of assessment data elements to help facilitate care coordination.
How Does the IMPACT Act 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 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:
- Making care safer by reducing harm caused in the delivery of care.
- Ensuring that each person and family is engaged as partners in their care.
- Promoting effective communication and coordination of care.
- Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
- Working with communities to promote wide use of best practices to enable healthy living.
- Making quality care more affordable for individuals, families, employers and governments by developing and spreading new healthcare delivery models.