Case Management

Harnessing the power of the discharge summary

Case Management Insider, March 17, 2015

Studies consistently show that an effective and complete discharge summary, which contains the content required by the Joint Commission, can help patients and prevent readmissions. Effective and complete discharge summaries do this by giving the patient, caregivers, and post-acute care providers the tools they need to address and manage the patient’s care needs, and help to ensure patients get necessary follow-up care, says Glenn Krauss, RHIA, BBA, CCS, CCS-P, CPUR, CCDS, C-CDI, executive director of the Foundation for Physician Documentation Integrity.

 
The better care a patient gets after discharge, the less likely he or she is to wind up back in the hospital. That’s a big deal nowadays, because hospitals face financial penalties for excessive readmissions. Under Medicare's Readmission Reduction Program, hospitals can now be docked 3% of their base payment for all discharges for excessive readmissions for five conditions, including congestive heart failure, pneumonia, myocardial infarction, joint and knee replacements, and chronic obstructive pulmonary disease, Krauss says. The government is not alone—other payers are following suit. Commercial payers often won't reimburse readmission cases. Instead, the second admission is rolled into the first admission and treated as one patient encounter, he says.
 
When a readmission occurs, case managers may find themselves under scrutiny.
 
“Whenever readmissions do occur, the immediate reaction is often to question the effectiveness and appropriateness of the discharge plan and ask whether the case manager/discharge planner did his or her homework,” Krauss says. Instead, what facilities should really be doings is looking at the discharge summary to gauge its quality, because often the discharge plan is only as good as the information used to create it.
 
Case management should work with the organization’s clinical documentation improvement specialists to make sure this content is complete and clear, to increase the effectiveness of the overall discharge plan, he says.
 
“Clinical documentation improvement (CDI) specialists, by definition and purpose, review the inpatient record for completeness, accuracy and specificity of diagnoses,” says Krauss. “Why not take advantage of their skill and mind set of clinical documentation improvement and encourage their active participation in affecting positive change in clinical documentation effectiveness and completeness in the discharge summary.”
 
Working together, case management and CDI can make improvements that help keep patients out of the hospital once they are discharged to the next level of care—which is a win for both the facility and the patient.

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