Critical Path Network

Be careful in discharging patients on Friday

They're more likely to be rehospitalized

Patients who are discharged to the hospital with home care on Fridays are more likely to be readmitted to the hospital within a week than patients discharged on other days of the week,1 according to Elizabeth E. Hogue, Esq., a Washington DC-based attorney specializing in health care issues.

"The reasons for this disparity remain unclear, but one possible explanation could be that hospital discharge planners or case managers are anxious to discharge as many patients as possible before the weekend," she says.

If patients are sent home on Fridays when they really do not belong at home, they are more likely to experience deterioration in their conditions, which can put them back in the hospital, she adds.

Hogue recommends that case managers and discharge planners be especially careful when they discharge patients on Fridays with a referral for home health services.

If the patient is readmitted for the same condition, it may impact the hospital's bottom line and could put the person who created the discharge plan at risk for a lawsuit charging negligence, she adds.

"According to national standards of care in Medicare Conditions of Participation, discharge planners and case managers have a duty to develop and implement appropriate discharge plans. They may be liable if they breach this duty and cause injury or damage to patients," Hogue says.

Patients who are appropriate for post-acute services in the home must be able to either care for themselves or they must have a paid or voluntary caregiver available to meet their needs in between visits from the professional staff, Hogue says

In addition, case managers should be certain that their patients' clinical needs can be met at home and that their home environments can support home health services, she says.

"When one or more of these criteria are not met, discharge planners are putting themselves at risk for legal liability," she says.

In addition, discharge planners and case managers should make sure that all post-acute providers receive all of the information they need to efficiently and effectively provide the care the patients need after discharge.

"Discharge planners and case managers must be sure to communicate complete and accurate information to post-acute providers. The tendency on Fridays may be rushing to get as many patients discharged as possible to the detriment of the planning process," Hogue says.

The Centers for Medicare & Medicaid Services (CMS) already is using the rates of rehospitalization as one of the quality indicators it uses to evaluate home health agencies, Hogue points out.

"This quality indicator will become more crucial when pay-for-performance is implemented because home health agencies' reimbursement will depend on low rates of rehospitalization," she says.

The response by home health agencies may be to decline to accept patients on Fridays in order to lower rates of rehospitalization, Hogue points out.

"It is clearly in the best interest of both discharge planners and post acute provider to further consider the disparity in rehospitalization rates and to work together to reduce it in order to manage risk and maintain reimbursement rates that support financial viability," Hogue says.

Reference

  1. Rowan, T. (October 26, 2006). Data analysis exercise: Beware of "Friday's child." Home Care Automation Report.

[For more information, contact:

Elizabeth E. Hogue, Esq., e-mail: ElizabethHogue@ElizabethHogue.net.]