Discharge planners work to control growing lists
Discharge planners work to control growing lists
Hospitals manage to maintain list and compliance
Nearly three years have passed since the Balanced Budget Act went into effect, and discharge planners have had time to identify and implement methods of reducing the headaches associated with what many simply call "the List."
The law requires hospital discharge planners to provide Medicare patients needing home health care with a list of certified facilities, so they can choose their own postacute care rather than being referred to a hospital-owned facility. In order to be placed on the list, a home health facility must make a request, be Medicare-certified, and service the area.
The list has caused problems within some hospitals, growing from one or two pages to 10 or more. Hospitals in rural settings have more manageable lists — sometimes totaling only seven facilities — but many big-city hospital discharge planners are facing ongoing aggravation trying to compile the list, update it, and explain it to patients without inadvertently swaying them toward a hospital-owned facility.
Getting the list together
The chore of compiling and updating the list is particularly time-consuming for some facilities in the Northeast that service patients in different states.
For example, Kathy Rickard, associate director of clinical resource management and social work at the University of Pennsylvania Health System in Philadelphia, says patients who walk through her doors are from upstate Pennsylvania or other states including New York, New Jersey, and Delaware. Certification requirements can differ from state to state, forcing discharge planners to be abreast of more rules and regulations.
"Compiling the list is a labor-intensive issue initially," Rickard says. "Then after that, it’s just updated. But I don’t think we could ever have
a list of every agency out there." To date, the health system has more than 75 facilities on its list.
One tool that has helped staff at the 600-bed University of Pennsylvania Health System is the Internet. "You can get a better list because of the Internet," Rickard says.
Lynne Jackson, RN, discharge planning coordinator at Maine Medical Center in Portland, says there are 28 HHAs on her hospital’s list. "[When the law took effect] it was a little extra work, but it’s not that much trouble," she says.
"Over the years, facilities have gotten to know us, and sometimes patients refer facilities to us," Jackson says.
Maine Medical Center, which serves patients in Maine and New Hampshire, is affiliated with a home health facility, but as Jackson says, "We try to determine with patients which is the best for their needs. If the patient chooses [an HHA] that cannot fit his or her needs, we let them know."
Compiling several lists based on services and patient care needs is the easiest method of avoiding the possibility of overwhelming the patient, says Jackie Birmingham, RN, MS, vice president of E-Discharge of Hartford, CT.
And according to Denise Kress, MS, RNC, CRRN, director of case management at Winchester (MA) Hospital, handing an elderly patient a list of 100 HHAs can create stress. "A lot of them have had home health in the past, and sometimes they can’t remember the name of the facility they used — all they can remember is that their nurse’s name was Nancy."
But Birmingham says because a majority of hospital discharge planners work with specific groups of patients and they have dealt with those groups over time, they should know through experience which facilities in the area can handle which types of patients.
Solving the problem of too many on the list
When the law first went into effect, Kress says Winchester created a long letter that included a list of every home care agency in the area.
"Case managers gave patients the list, and what we found was that especially elderly people were overwhelmed by it," Kress says. "They didn’t want to make decisions without other people [family] present, especially since they were being asked to sign something about the fact that they had been given a choice. They just felt uncomfortable."
Furthermore, she says it became difficult and time-consuming to get the list completed. "So we changed the letter to a more generic letter and we also whittled down the list to the home care agencies that are in this geographic area. And we found that a lot of them had closed."
If a patient requests an HHA outside Winchester’s area, that’s not a problem, but the hospital is keeping its list short to make it easier on the patient. In fact, it only consists of one page. On one side of the sheet is a letter, and on the other side is a list of the facilities. Since the law took effect, the list has dropped from about 30 down to a manageable 10 to 12.
If home care is an option when the case manager discusses the discharge plan with a patient, the case manager will ask if the patient has a preference or if he or she has ever used an agency in the past.
"Nine times out of 10, the patients say, whichever one you think is fine,’" Kress says. "What is very difficult and the real intent of the law is that there is no steering going on. Our hospital does have its own home care agency, but we make sure the patient has a choice."
Winchester case managers are required to document in their notes that the patient was given a choice. And finally, the hospital audits charts on an ongoing basis to ensure that patients and families were given a choice.
For more information, contact:
Kathy Rickard, associate director of clinical resource management and social work, University
of Pennsylvania Health System, Philadelphia. Telephone: (215) 662-2375.
Lynne Jackson, RN, discharge planning coordinator, Maine Medical Center, Portland. Telephone: (877) 339-3107.
Jackie Birmingham, RN, MS, vice president,
E-Discharge, Hartford, CT. World Wide Web: www. lhm.com.
Denise Kress, MS, RNC, CRRN, director of case management, Winchester (MA) Hospital. Telephone: (781) 756-4760.
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