By Wayne Sensor, CEO, Ensocare
On October 29, 2015, CMS proposed a new set of discharge planning requirements that hospitals and other care providers must meet to receive Medicare and Medicaid reimbursement. According to CMS, the proposed rules are meant to modernize the discharge function and help organizations improve care quality and avoid adverse events, such as unnecessary complications or hospital readmissions. The comment period for these proposed standards ended in January, and organizations await the final rules. Although no one knows exactly when the rules will release or what form they will take, there is consensus that the final regulations will be similar to those proposed, and organizations will be required to comply with them sooner rather than later.
Overall, the new CMS regulations strongly emphasize the importance of taking the patient’s clinical needs, care goals, and psychosocial preferences into account when planning for discharge. The main idea is that if organizations place the patient at the center of the planning process, they will improve patient health outcomes, enhance satisfaction, reduce care costs, and limit the likelihood of medical errors.
To meet the CMS standards, organizations must commit to reexamining and potentially revamping their discharge processes. The following sections look deeper into a few topics addressed by the rules, discussing how technology can facilitate compliance.
Develop Discharge Instructions Within 24 Hours Of Admission
Once a patient is diagnosed, providers often have a line of site as to the type of post-discharge care the patient will need and the kind of facility that’s appropriate. However, many organizations wait to start discharge planning until the patient is ready to leave the hospital. By starting the process earlier in the patient’s stay, organizations can better manage their avoidable days and give patients and their families more time to vet the appropriate facilities. Using discharge planning technology, for example, organizations can send out multiple electronic requests to potential providers at the same time and learn within thirty minutes which facilities in the area are able to accept and support the patient. This allows the hospital to offer the patient and family a “short list” of organizations early on in the patient’s hospital stay, giving them more time to efficiently review their options, identify preferred providers, and make choices without having to add unnecessary days to a patient’s stay or associated expenses.
Share Detailed Information Between Facilities
The quality and quantity of patient information that organizations exchange at discharge varies significantly. On one end of the spectrum, a hospital may supply very little information to a post-acute provider; on the other end, it may send a copy of the entire medical record with the patient, overwhelming the post-acute organization. Neither option is acceptable, and an organization must find ways to achieve a happy medium. Discharge planning software offers one solution, letting a hospital easily extract information from the EHR that is specific to the patient’s current condition, medications, and required care. The hospital can then send this data electronically to the receiving organization in a quickly-digestible format. This gives the receiving facility all the information it needs to start therapy and appropriately care for the patient, ensuring there are no lapses in care or delayed or duplicated treatments.
Consider Non-Healthcare Community Services
Not every patient released from a hospital will need to go to a step-down facility; in many cases, a hospital sends a patient home. However, this individual may still require services, such as meals, regular blood pressure checks, household help, and so on. Historically, hospitals have not been able to reliably connect patients with appropriate community resources. In the best case scenario, a hospital supplies the patient with a pre-printed resource list, encouraging the family to reach out to the providers on the list at their convenience. However, by embedding community provider information into discharge planning technology, hospitals can proactively reach out to applicable resources electronically, matching patients with suitable organizations and lining up services before the individual leaves the hospital.
Follow-Up With Patients After Discharge
The CMS rules require hospitals to conduct some type of post-discharge follow-up. To handle this, a number of organizations are looking to supplement their discharge staff so they can make phone calls to patients at certain points after they leave the hospital. Unfortunately, this manual approach does not take into consideration a patient’s risk for readmission. So, an organization can spend a lot of time following up with patients but still not prevent their return to the hospital. By engaging in a risk stratification process, however, organizations can pinpoint which patients have the greatest likelihood for readmission — for example, those with several comorbidities and limited family support — and make sure they follow-up with those people first, using more high-touch interactions. Organizations can then rely on automated follow-up for the less at-risk patients. By employing technology solutions in this fashion, organizations can efficiently ensure patients’ post-discharge needs are being met and avoid repeat visits to the hospital.
The CMS regulations present an opportunity for hospitals and other healthcare providers to improve their discharge planning processes. By leveraging technology, organizations can enrich communication between providers, streamline discharge tasks and fully meet patients’ needs before and after they leave the hospital.