Guidelines updated for discharge planning

Continuing to emphasize the importance of discharge planning and preventing unnecessary readmissions, the Centers for Medicare & Medicaid Services (CMS) has issued a revised set of Discharge Planning Interpretive Guidelines that surveyors will use to assess a hospital's compliance with Medicare's Conditions of Participation.

"There is increased emphasis on discharge planning by CMS, and these revised guidelines attest to the importance of a good discharge plan and a smooth transition, which can help to prevent unnecessary readmissions," says Sue Dill Calloway, RN, MSN, JD, CPHRM, CCM, CCP, president of Patient Safety Education and Consulting in Dublin, OH. "CMS is encouraging hospitals to develop a discharge plan for all inpatients, whether they are Medicare recipients or not."

The 39-page document outlines what CMS expects hospitals to do in order to comply with the Conditions of Participation regulations and interpretive guidelines and includes instructions on what the surveyors should assess when they review hospital records. They include specific criteria for evaluating patients, creating a discharge plan, and improving transitions from the hospital to home or another level of care.

Jackie Birmingham, RN, MS, vice president emerita, clinical leadership for Curaspan Health Group in Newton, MA , says, "Surveyors will be looking for documentation that hospitals are complying with the Conditions of Participation and initially will select a group of charts to review for evidence of discharge planning evaluation activities. If they see a pattern of non-compliance, they may review more charts, order the hospital to create an action plan for improvement, then come back for another review." Ultimately, not being in compliance could lead to a loss of Medicare funding, she adds.

Birmingham suggests that managers familiarize themselves with the guidelines and what the surveyors will be checking and use them as a guide for developing best practices for patient care and transitions.

New in this version of the Interpretive Guidelines are what CMS call "blue boxes." The "blue boxes" make suggestions that hospitals can use in improving discharge planning and care transitions.

For the first time, CMS asks surveyors to employ the tracer methodology on several closed and open inpatient records to determine if hospitals comply with the Conditions of Participation. (To read the guidelines, go to http://go.cms.gov/15Wo9f5.)