Case Management

New tool can help discharge planning process

Case Management Insider, February 17, 2015

With readmission penalties increasing to 3% this year, and the addition of new conditions to the Readmission Reduction Program—chronic obstructive pulmonary disease, elective total hip arthroplasty, and total knee arthroplasty—it’s more important than ever to focus on discharge planning.
"Case management, utilization review/management in taking the lead to reduce financial exposure and as part of a quality management and outcome focus, should be developing internal tools and screens based upon previous readmission patterns for the five specific diagnoses under the Readmission Reduction Program,” says Glenn Kraus, BBA, RHIA, CCS, CCS-P, PCS, FCS, CPUR, C-CDI, CCDS, executive director of the Foundation for Physician Documentation Integrity.
While it’s important for case managers to work on these areas, it’s often a task that is easier said than done. However, a new report may help case managers direct their efforts. In January, the American Hospital Association (AHA) released a report called Private Sector Hospital Discharge Tools. The guide was created after a brainstorming session involving five different organizations that have been working to improve patient transitions from one level of care to the next.
This AHA technical advisory panel looked at a number of discharge tools already in use to identify common themes and best practices. What the panel found is that discharge tools generally shared three major themes:
  1. Ensuring that the patient was placed in the most appropriate post-acute care setting
  2. A goal to reduce readmissions
  3. Helping to manage patient transitions from the hospital to the post-acute setting
From their analysis, the group boiled discharge plans down to what the technical advisory panel says are five lessons that should be considered when developing discharge planning or patient assessment tools, including:  
  1. Post-acute care placements should be based on a patient’s clinical needs. Getting the post-discharge setting right the first time can help prevent avoidable readmissions.
  2. Discharge planning tools should include the medical judgment of the patient’s physician and other members of the clinical team. This is a good plan considers both clinical and non-clinical variables.
  3. Avoid designing tools that create more administrative paperwork for staff members.
  4. Discharge planning tools should strive to help physicians and other clinicians optimize patient health while in the hospital setting to help reduce the need for post-discharge services. Tools should be easy to use and not create more work as this may lead providers to shy away from their use.
  5. Use tools to collect standard information about the patient to reduce variations in post-acute placement and to reduce readmissions. Focusing on discharge planning at the start of hospitalization can help optimize care and help improve patient health.
“A sound place to start in a discharge improvement effort is by is identifying patterns of diagnoses associated with the five diagnoses from the initial admission as well as types of diagnoses patterns associated readmissions,” says Krauss. Including the five AHA elements as part of your planning process can help ensure the patients who are discharged make a successful transition to the next level of care.
To view a full copy of the report, click here and scroll down to Private Sector Hospital Discharge Tools, January 2015.

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