Are your discharge planning failing for patients?


Upon discharge from hospital, uninformed patients often face time-pressed decisions about finding a suitable post-acute care provider.

Discharge from hospital to a post-acute care setting is often one of the most daunting challenges patients and their families face.

a valued one in five hospitalized patients is referred to post-acute care facilities such as skilled nursing facilities (SNF) or long-term care hospitals. However, decisions are usually rushed and options are often unclear, which can lead to placements with poor quality care and negative outcomes such as hospital readmission.

A recent report of the United Hospital Fund has found that discharge planning can fail in patients seeking to find high-quality post-acute care providers.

“The system-centered interests of payers, providers and regulators often take precedence over the needs of patients, while the interests of patients, whose recovery is at stake, must come first. post-acute care options, an ingredient that should be critical to vacation planning, is hard to find and risky if missing, ”the report researchers wrote.

Patients and their families face several obstacles when selecting post-acute care providers, according to the United Hospital Fund report.

  • In a rapid discharge process that typically lasts less than 48 hours, patients and families play a leading role in finding post-acute care providers who are often unfamiliar with the services offered or health insurance coverage.
  • The quality of care varies from provider to provider, which can lead to poor results and high costs.
  • In markets with multiple providers, patients and their families are generally ill-equipped to make informed decisions.
  • Most patients want hospital staff to help them find providers for post-acute care, but federal law gives Medicare beneficiaries the choice to select providers and prevents hospitals from offering specific recommendations.
  • Post-acute care is expensive. In 2016, the cost of care for Medicare beneficiaries in post-acute settings was over 60 billion dollars.

During the discharge process, patients and their families often receive bewildering lists of providers, the report’s authors wrote.

“Patients who will be discharged home with the services of a certified home health agency usually receive a list of the names, addresses and phone numbers of agencies in the surrounding area and are asked to choose an agency. When post-acute care in a facility is required, discharge planners distribute similar contact lists for NFCs located in the area, indicate which ones accept a patient’s insurance, and ask patients to identify multiple choices ” , they wrote.

Better vacation planning

Hospitals and their discharge teams can help patients and their families meet the challenge of selecting the right post-acute care providers, the report’s co-author told HealthLeaders this week.

“There are many compromises involved in many decisions about post-acute care that discharge planners might discuss with patients and family members. This type of guided discussion or review could help patients and families assess the pros and cons of their options and determine how priorities and needs might be best considered, ”said Lynn Rogut, director of measuring the quality and transformation of care at the Quality Institute of the United Hospital Fund.

Reengineering discharge planning to make it less complex is a significant hurdle for hospitals, Rogut said.

“Overall, discharge planning continues to lack standardized protocols, and this can vary from patient to patient and hospital to hospital. Placing patients at the center and standardizing the process as much as possible might start to help, but the involvement of external parties such as health plans, individual patient needs and other “system” constraints will also need to be included. be taken into account, ”she said.

Discharge planners should strive to help patients and their families understand their options, Rogut said.

“The range of options available to each patient may be limited by medical care needs, social factors such as home environment, insurance coverage, availability of community services and supports, and many other factors. explain the full range of options available at home, in the community, such as adult day care, assisted living or skilled nursing facilities. They also need to make sure that patients and families understand and know what to expect from post-acute care services. “

Online information

Patients and families often turn to online resources to find post-acute care providers, wrote Rogut and his coauthors.

Most hospital discharge planning staff refer patients and family caregivers to ‘Compare’ sites for home health agencies and nursing homes that are sponsored by the Centers for Medicare & Medicaid Services (CMS ). Home Health Compare contains performance scores for all Medicare-certified home health agencies based on insurance claims data, standard patient ratings agencies submit to CMS, and other information collected by state regulators and CMS, ”they wrote.

Home Health Compare offers a pair of stars: one evaluates the quality of care and the other reflects the patient experience.

Comparison of retirement homes provides stars for Medicare and Medicaid certified nursing homes. Star ratings reflect the results of state health inspections and the data nursing homes submit to CMS on staffing levels and quality performance.

Yelp and Facebook have reviews of SNFs and home health agencies. However, the report’s co-authors claim that these websites are not as reliable as comparison sites. “Until the number of consumer reviews increases, they can be subject to bias and should be interpreted with caution,” they wrote.

Christopher Cheney is the clinical care editor at HealthLeaders.


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