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CMS just finalized new discharge planning rules. Here's what you need to know.

October 23, 2019

    Each year, millions of patients must decide where to receive post-acute care following an inpatient admission.

    Access strategies for raising the quality floor of your post-acute market

    For patients and families, this decision often comes after a short, unexpected, and often traumatic hospital stay. Patients and their caregivers may lack helpful guidance when selecting a post-acute provider and are often unaware of the benefits and risks associated with their choice.

    For hospitals, the patient's decision to select a post-acute provider is only one step in a multi-step discharge planning process that is often fraught with roadblocks and delays as providers coordinate care across siloed settings. Additionally, hospitals may feel uncomfortable providing patients with advice on selecting a post-acute provider due to anti-kickback regulations.

    Ultimately, an uninformed decision can result in a patient’s transition to a low quality provider that is ill-equipped to manage care. Less-than-ideal post-discharge outcomes can not only worsen a patient's condition, undoing clinical improvements delivered in the acute setting, but can also hurt a hospital’s financial performance—resulting in readmission, mortality, or penalties under the Hospital Value-Based Purchasing program's Hospital Consumer Assessment of Health Care Providers and Systems—and increase the total cost of care.

    CMS' new discharge planning rules

    To that end, CMS has finalized two discharge planning rules that aim to help providers equip patients with helpful guidance when selecting post-acute care.

    Rule 1: This discharge planning rule requires hospitals to provide patient access to post-acute providers’ quality and resource-use measures, such as number of pressure ulcers, proportions of falls that lead to an injury, and readmission rates.

    Rule 2: This rule states that skilled nursing facilities with abuse, neglect, or exploitation citations will now have a consumer alert icon next to their name on Nursing Home Compare.

    In short, CMS wants hospitals to provide patients with necessary information about the clinical performance of their post-discharge options.

    Below are two strategies health systems can incorporate to discuss and promote meaningful post-acute quality measures with your patients.

    Help patients choose high-performing, in-network providers

    Many health systems have already put in the work to create a post-acute network of providers with proven quality outcomes, but struggle to discharge patients to these settings. To drive meaningful volumes to high-quality, in-network partners, providers should implement patient education resources that aid decision-making.

    For example, patients can receive post-acute scorecards that list quality measures of nearby facilities or have conversations with discharge planners who explain which providers are preferred and why they can provide guidance while maintaining patient choice rules.

    Collaborate to raise the quality floor of your post-acute market

    Patients may have to use out-of-network providers due to personal preference or provider constraints. In these markets, hospitals can support their post-acute partners, both in-network and out-of-network, with quality improvements to boost patient outcomes. 

    For example, supplying providers with telehealth monitoring options or offering downstream staff training to care for clinically complex patients can improve post-acute providers' abilities to manage complex patients. Additionally, collaborative meetings with downstream providers can identify existing challenges that health systems and PACs can work together to address.

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