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After more than a decade operating as a federally supported demonstration project, the Program of All-Inclusive Care for the Elderly (PACE) is now recognized as a permanent provider under Medicare and a state option under Medicaid. More than two dozen sites serving Medicaid and dually-eligible patients currently are in operation nationwide. Approximately 17,000 persons are being served through the various sites. PACE participants are impaired and frail elderly who are nursing home eligible. The Balanced Budget Act of 1997 (BBA [P.L. 105-33]) in establishing PACE as a permanent provider also mandated that the quality of care that PACE enrollees receive be monitored. In 1997, the Centers for Medicare & Medicaid Services (then HCFA) contracted with the University of Colorado Center for Health Services Research (CHSR) to develop a quality assurance system for PACE and its frail elderly participants. In 1999, CMS (then HCFA) published an interim final rule that described a planned reporting system for PACE that was envisioned to be quite similar to the quality performance reporting system now mandatory for home health agencies that serve Medicare beneficiaries. By the time the CHSR project, funded through contracts with CMS, ended in 2004 it had created a set of outcome measures and a complex system of "Outcome-Based Continuous Quality Improvement (OBCQI)." The contract also encompassed development of a set of data elements with which to both evaluate participants at two points in time and compare (across sites) participant health status, home and environmental circumstances, and socio-demographic factors. After measures were tested, a number of potential elements were eventually omitted. At the end of the contract, the contractor named the data collection/participant assessment form that emerged "Core Outcome and Comprehensive Assessment – Basic (COCOA-B) Data Set". The contractor also created a preliminary method for risk adjusting outcome data so comparisons could be made among sites. PACE sites provided feedback to the contractor, during testing phases of the contract. CMS is posting the COCOA-B data collection tool (Appendix 6) for individual PACE sites to use if they choose to implement this method to collect and analyze data for their own participants. The data collection instrument, COCOA-B, was developed with federal funds and is in the public domain, so anyone is free to use it as they wish. In addition to the data collection instrument, we are posting additional background analyses conducted during the course of the contract. Materials that follow are excerpted from a report submitted by the University of Colorado Center for Health Services Research. The report and all materials were created under contract with CMS. We have retained most of the original, lengthy report and appendices for the use of PACE sites that participated in development and testing work and may be interested in descriptions of methodology and findings. Chapters and tables in the narrative report have been renumbered to accommodate edits. Recommendations are those of the University of Colorado Center for Health Services Research and do not reflect CMS policy. Some assumptions and recommendations by the contractor have been omitted because they presume creation and maintenance of a central database, creation of outcome reports, and implementation of comparative analyses of the various PACE sites. While language has been edited to clarify that statements represent the contractor's view and not CMS policy, there may be residual content or tone that reflect the contractor's perspective, recommendations, or assumptions. Individual sites would probably implement the concepts of risk adjustment and outcome based continuous quality improvement differently than the methods described in this report if their focus is to be on assessing their own performance and quality over time.
Page Last Modified: 02/23/2006 3:57:00 PM
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