Discharge planning is CMS' focus

Help your hospital's HCAHPS scores

As the Centers for Medicare and Medicaid Services (CMS) continue to increase its focus on discharge planning, case managers need to pay more attention than ever to ensuring that patients have the information they need to make informed choices about their discharge destination, says Jackie Birmingham, RN, MSN, MS, nurse educator/consultant in discharge planning and vice president emeritus, clinical leadership at Curaspan Health Group, a Newton, MA, healthcare consulting firm.

CMS has announced its intention to add three new questions about discharge planning to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey some time in 2012. They will be in addition to the three questions regarding discharge that are part of the 27-question HCAPHS survey currently being used.

The three additional questions are:

  • Did the hospital consider the patient's preferences regarding post-discharge healthcare needs?
  • Did the patient understand his own responsibilities in managing his health after being discharged?
  • Did the patient understand the purpose of his discharge medications?

Case managers should pay particular attention to the question on patient preference regarding post-discharge needs because they own the discharge planning process, Birmingham says. In addition they should work with the nursing staff on patient education and get pharmacists involved in medication reconciliation, she says.

"Discharge planning is the most patient-centric function in the hospital. Case managers need to talk to patients and take their specific needs and preferences into account when they develop a discharge plan," she says.

The Medicare Conditions of Participation require hospitals to provide patients with a choice of options for the appropriate next level of care. Medicare has emphasized that hospitals should give patients "real options" for post-acute services, Birmingham adds.

This means that case managers need to do more than just handing the patient a list of providers and/or asking, "what skilled nursing facility, home health, or hospice program do you prefer?" It means finding out which providers can meet the patient's needs and have beds available, and then giving them those options, Birmingham says. "Case managers should narrow the options and give patients the information they need to make an informed decision," she says.

If you ask patients for their preference, without first checking on availability, and the facility they choose isn't available, they are likely to have the perception that they are going to their second choice, she points out. In addition to affecting the hospital's HCAHPS scores, in some cases, it could affect readmissions, she says. "When patients feel like they had to take their second choice for a post-acute provider, and they don't like their room or the food, they may insist on going back to the hospital," she says.

The HCAPHS scores are important to hospitals because the results are publicly reported data that may affect referrals and patient choice, Birmingham says. In addition, in the future, under value-based purchasing, a percentage of Medicare reimbursement is going to be based on the HCAHPS scores," she says.

Birmingham suggests that case managers receive training on communication, interpersonal skills, and how to talk to people who are sick, to find out their post-discharge needs and preferences. "Hospitals need a communication specialist to work with case managers who do discharge planning and teach them how to ferret out the real issues patients have," she says.

Hospitals need to develop a way to identify appropriate and available beds in real time so the discharge planners can give patient's viable options, she says.

Keep in mind that it is permissible for case managers to include post-acute services owned by the hospital in the list of options for patients as long as they tell the patient that there is a financial interest, she says. "Hospital case managers must look at what is best for patients, as well as the business interest of the hospital and to do that, the entire team needs to sit down and develop an effective mechanism for giving choices to patients," she says.

Get ahead of the curve by finding out patient complaints about their discharge and their discharge destinations, and determine what is working well and what needs to be improved, she says.

Look at your hospitals existing HCAHPS scores for discharge-related questions. "If a hospital is trending low, it's likely the trend will continue with the new questions," she says.

Take time to talk with patients about the next step in the treatment process. Answer their questions and listen to their concerns, she says.


For more information, contact:

  • Jackie Birmingham, RN, MSN, MS, Nurse Educator/Consultant in discharge planning, and Vice President Emeritus, Clinical Leadership at Curaspan Health Group, Newton, MA. E-mail: jackiebirmingham@jackiebirmingham.com.