By Jeanie Davis
New rules intended to help empower patients preparing to move from acute care into post-acute care will soon govern hospital discharge planning, according to the Centers for Medicare & Medicaid Services (CMS).
Under the new rules, which take effect Jan. 1, 2020, hospitals must:
• Focus on patients’ care goals and treatment preferences in discharge planning;
• Assist patients in selecting a post-acute provider by sharing relevant quality performance data for those facilities, including readmission and patient fall rates;
• Ensure each patient can access an electronic version of their medical records.
“Today’s rule is a huge step to providing patients with the ability to make healthcare decisions that are for them and gives them transparency into what used to be an opaque and confusing process,” CMS Administrator Seema Verma said in the news release. “Patients will now no longer be an afterthought; they’ll be in the driver’s seat, playing an active role in their care transitions to ensure seamless coordination of care.” (The statement is available online at: https://go.cms.gov/2nG60nd.)
Currently, the hospital case manager will prioritize patient choice in developing treatment plans, explains Elizabeth Lamkin, MHA, CEO of PACE Healthcare Consulting. “However, that approach has led to questions about just how much information they should provide,” she explains. “Discharge planners have referred patients to home health agencies they have worked with in the past, and might include agencies operated by friends.”
The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 requires hospitals and post-acute providers to include quality scores while helping patients and families during the discharge process. The IMPACT Act was intended to encourage patients to become more active in planning their post-acute transitions. Since then, public feedback has indicated that significant policy issues must be resolved.
The Medicare Payment Advisory Commission (MedPAC) and other groups have called for more clearly defined discharge planning. Current rules that strongly emphasize patient choice have left some hospital discharge planners worried about overstepping their role, according to MedPAC.
Typically, CMS’ Home Health Compare is not effective in steering patients toward the highest quality providers, according to MedPAC. The commission also has argued that CMS should give discharge planners more authority and flexibility in guiding patients toward top home health agencies.
The Case Manager’s Role
“Increasingly, the hospital has responsibility for the entire episode of care. Identifying resources in the community is an important part of that process,” Lamkin says. “Patient choice and providing more than just a list of post-acute providers, in my opinion, is not a new thing. Discharge planners have always had the ability to provide information on home health services. If there are higher-performing patient services available, or a provider has specialty services, the patient has a right to know that.”
“CMS requires hospitals to get feedback and evaluate providers if they have a contract,” Lamkin explains. “Most hospitals are now contracting with high-quality post-acute providers, and those report quality data to the hospital. The hospital should request metrics about readmissions.”
The case manager can explain the services these providers offer, if they fit the patient’s needs, and what quality information they have about the provider, explains Patricia Hildebrand, RN, MSN, executive director of Hildebrand Healthcare Consulting in Sugar Land, TX. “You can’t just hand them a list to choose a provider; you have to give the patient explanations.”
Discharge planners are required to inform the patient if they have a financial interest in a provider. “They may have a bias in favoring certain providers, but information on those providers should be available for all involved in the decision, including social worker and the patient, so they can make quality-based decisions,” Hildebrand explains.
The big debate is which information is most useful to the patient to decide, she adds. “It’s all about educating consumers. If rankings on comparing websites are not affecting patients’ decisions, there may be other factors that need to be addressed.”