In an effort to increase acute and post-acute care coordination and improve health outcomes, the Affordable Care Act established penalties in October 2012 for hospitals that have high readmission rates for heart attack, heart failure and pneumonia patients. Moving forward, readmissions related to chronic obstructive pulmonary disorder and knee and hip implants would be added under the proposed CMS rule. The maximum readmissions penalty is set to rise to 2% next year, on the way to a maximum of 3% in 2015, per the ACA.
In addition, the Centers for Medicare & Medicaid Services has revised the State Operations Manual’s Hospital Appendix to clarify the discharge planning requirements for hospitals, giving more in-depth guidelines around discharge planning. The goal is for hospitals to reduce readmissions by partnering with post-acute providers.
Hospitals must have discharge planning processes in place for all inpatients, including:
- Screening all inpatients to determine which ones are at risk of adverse health consequences post-discharge if they lack discharge planning to include assessment of whether a patient’s post-discharge needs can be met in his or her next environment, such as a skilled nursing facility and consideration of whether the patient’s insurance would cover needed services in the next care setting
- Evaluation of the post-discharge needs of inpatients identified in the screening process, or of inpatients who request an evaluation, or whose physician requests one and development of a discharge plan if indicated by the evaluation or at the request of the patient’s physician
- Initiation of the implementation of the discharge plan prior to the discharge of an inpatient.
The hospital is responsible for initial implementation of this discharge plan, including arranging the transfer, and providing information to the patient about the goal of treatment in the next setting. The revised guidelines also include new information about the requirement to give patients with skilled nursing needs a list of potential SNFs. Hospitals must disclose certain financial interests in these nursing homes. The guidelines include a bulleted list of medical information that the hospital must give to the next care provider, such as a copy of the patient’s advanced directive, if there is one.
Surveyors are not to cite hospitals for failing to adopt these practices; however, hospitals are encouraged to obtain input from healthcare facilities and professionals who provide care to discharged patients.
So, if you have not yet reached out to your hospital referral sources, now is the time to do so. It is clear that this initiative is not going away anytime soon and all that aside, it is the right thing to do for the patients we provide services to.