Everything you need to know about the PACIO Project

November 2, 2022
Categories: Home health
Reading Time: 3 minutes

By: Chris Pugliese, Director of Product Interoperability, ResMed SaaS

The fundamental structures supporting healthcare data exchange have been targeted to, advanced and refined by acute and ambulatory care settings and software platforms supporting them. Out-of-hospital providers have traditionally been left out of any regulations involving data exchange provisions and therefore have also been excluded from much of the funding made available to facilitate this digital transformation. While arguments can be made that this hands-off approach allowed for more focus on innovation, an unintended result is that out-of-hospital providers have ended up years behind their acute and ambulatory counterparts when it comes to supporting interoperability.

Out-of-hospital care has unique differences that have largely been unaccounted for in advancements of new interoperability initiatives. Data standards, for example, define how records are digitally reflected and shared, but until recently have been built without any consideration for post-acute providers. As noted, out-of-hospital providers have specific needs, and one key distinction is the length of time an out-of-hospital provider assumes responsibility for delivering services. Providers are interacting with patients for weeks, months, and years rather than hours or days, often broken apart by payor, regulatory, or accreditation requirements. Until recently, there has been no thought on a standard method for reflecting out-of-hospital needs into the emerging healthcare app economy.

This is where the Post-Acute Interoperability Workgroup, PACIO for short, aims to make an impact. Founded in 2019, and funded by CMS, the initiative aims to emulate the advancements in data exchange, with special focus on the out-of-hospital ecosystem. Since 2019, PACIO has published multiple post-acute-focused implementation guides, covering a variety of out-of-hospital needs.

The primary goal of the PACIO Project is to establish a framework for the development of Fast Healthcare Interoperability Resource (FHIR®) technical implementation guides and reference implementations that will facilitate health data exchange through standards-based use-case-driven application programming interfaces (APIs).

What is a re-assessment timepoint?

In 2021, to support our customers and the wider out-of-hospital provider network, MatrixCare worked with PACIO to develop the now published re-assessment timepoint standard, allowing post-acute providers to structure their admissions in a way that properly reflects the post-acute patient experience.

Re-assessment timepoint is an unfamiliar term to most, but the intended use should be familiar to all out-of-hospital providers. When a patient begins their Medicare admission in home health, an OASIS assessment is completed and a plan of care is generated for physician signature (after 60-days, the care team completes a new OASIS and a plan of care). The 60-day window, part of a longer admission, can be digitally reflected as a re-assessment timepoint. In addition, home health billers are sending out claims every 30 days, which can also be reflected as a timepoint.

Now that we have a data structure to represent smaller periods of time-defined regulation, payor billing cycles, accreditation agency requirements, or even standard operating procedures for a given provider, what can it be used for and why does it matter? Thinking about the length of an out-of-hospital admission, implementing a timepoint structure allows providers to reflect only the most current and up-to-date condition of the patient. Hospital case managers would otherwise be sifting through months of information while trying to triage the patient; the timepoint can make the home health provider a more valuable partner to the hospital. From the payor context, if a claim is being audited, the analysts reviewing the claim only want data from within the claim dates, so the timepoint can be used to automate the sharing of data to the pay0r — rather than the inefficient means that exist today.

The re-assessment timepoint implementation is intentionally flexible so that post-acute providers and their software vendors can develop ways to express patient records that ensure the right data reaches the right stakeholders at the right time. It is the first administrative structure specifically targeted for care settings outside acute and ambulatory provider types and sets the groundwork for further expansion and focus on technology to support post-acute providers.

An important piece of the larger puzzle

If there is one takeaway any provider should have, it’s that these foundations are imperative for supporting the exponentially growing senior population as well as the broader shift toward value-based care. If provider organizations and their software vendors can’t exchange in ways that meet the needs of patients, partners, and referral sources, they will find themselves on the wrong side of the innovation boom. PACIO is an important piece of the larger puzzle — working to provide the standard language, long missing and needed, for the broader healthcare market to communicate with post-acute providers. These providers and their software vendors alike must participate in this vital work to shape the future with home health and post-acute care in mind.

Helpful links



PACIO extends an open invitation to all providers and the software vendors that support them to their weekly and monthly calls. Access to the meeting is available on the PACIO website.

Request a demo to experience how MatrixCare is helping to lead the way for interoperability in post-acute care.

Chris Pugliese
Chris Pugliese

Chris Pugliese is a Senior Product Manager of Integration and Interoperability for MatrixCare. Chris has spent the last decade working with post-acute technology and EMRs, and the last 5 years focused on interoperability. His strength is enabling technology, as well as educating on the growing importance of interoperability and its benefits to the post-acute care settings. In a short time, Chris has become a leader, spearheading integration and interoperability initiatives within and outside of MatrixCare. Recent industry committee roles and responsibilities include: Leadership Team Member for the Post Acute Interoperability Work Group (PACIO), Technical Lead for the Functional Status Subgroup for the PACIO initiative – developing FHIR Profiles for Functional Status, CommonWell Health Alliance Use Case Committee member, CommonWell Health Alliance Specification Workgroup member

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