The Centers for Medicare & Medicaid Services (CMS) released a final rule Thursday that changes discharge planning requirements for home care providers. Overall, the changes are part of CMS’s efforts to make patients a more active part of their care transitions out of the hospital and into other settings.
“This respects President Trump’s executive order on promoting choice and competition in health care,” CMS Administrator Seema Verma said in a press call Thursday. “This represents a step forward in interoperability and the MyHealthEData initiative.”
Home care providers have long been asking policymakers to clarify the ins and outs of discharge planning, and some industry players expected CMS to update the guidelines last year.
In November 2018, however, CMS said it was delaying this step. Thursday’s news comes months away from CMS’s November 2019 target for an updated final rule on leave planning.
Under CMS’s recently announced discharge planning rule, patients and their families must have access to information that will help them make informed decisions about their post-acute care (PAC) options, including data on quality metrics and data on resource utilization metrics.
The rule also requires home health agencies to provide relevant data on quality measures and resource utilization measures to the patient and caregiver regarding their goals of care and treatment preferences.
Additionally, CMS will now require that a patient’s discharge needs assessment and discharge plan be documented in a timely manner. The assessment should be included in the clinical record and discussed with the patient or their representative – and any relevant patient information provided by the provider should also be incorporated into the discharge plan to avoid delays.
“Care transitions are a vulnerable time in a patient’s care,” Verma said. “If not handled properly, the undesirable outcome is often costly readmission or poor patient outcomes. Patients being discharged from an acute care facility need and deserve to know how their transition will be managed. This rule makes that reality.
Although CMS is calling for patients to be given more information about post-acute care options after a hospital stay, it still maintains its commitment to anti-robbery regulations.
Current rules and regulations prevent hospital discharge planners, for example, from pushing patients to a specific provider they may favor or have a business relationship with. Many planners have traditionally been reluctant to cross this line, sometimes leaving patients in the dark.
“I don’t think it has any impact [anti-steering]”, Verma said. “It’s about making sure that patients have information about what happened in the hospital so that when they go to a post-acute care provider, they may have this information for the provider.”
Officials from the National Association for Home Care & Hospice (NAHC) called the rule “planned,” adding that it implements requirements set out in the IMPACT Act.
“CMS has not finalized some of the more onerous requirements that have been proposed, such as prescribing when the home health discharge plan should be reassessed and prescribing what information should be sent to the receiving provider,” Mary Carr, vice president of regulatory affairs at NAHC, said in an emailed statement to Home Health Care News. “Concepts related to patient preferences, individual patient goals and needs, and patient involvement in discharge planning are key concepts that are already part of the [home health Conditions of Participation] in overall care planning.
In some ways, the final rule responds to the findings of the Medicare Payment Advisory Commission (MedPAC) regarding home health referrals.
Last year, MedPAC found that patients at home rarely choose the highest quality providers in their neighborhood after discharge from hospital.
“The concern to protect patient choice…makes some discharge planners cautious in the assistance they provide, even when patients seek their advice,” MedPAC said in its June 2018 report. of the health system fear that [CMS’s CoPs] do not adequately define permitted educational activities that respect the recipient’s freedom to choose an PAC provider. »
Overall, more than 94% of recipients who use home health agency services after discharge from hospital have at least one provider within 15 miles with a higher quality score than the provider they did. they finally chose, according to MedPAC.
On top of that, 70% of recipients have five or more home health agencies in their area known to provide better quality care.
“The Medicare Act gives beneficiaries the freedom to choose their PAC provider, and the laws state that hospitals cannot recommend providers,” Evan Christman, principal analyst at MedPAC. noted at a public meeting in March 2018. “The IMPACT Act created a new requirement that hospitals use quality data during the discharge planning process and provide it to beneficiaries. But the regulations implementing this new requirement have not been finalized.
Read the full text of the Final Discharge Rule here.