Discharge Planning Proposed Rule Focuses on Patient Preferences

The already large case load with burdening responsibilities related to competing agendas that every Medical Case Manager and or Social Worker juggles, is about to increase. The Centers for Medicare and Medicaid Services (CMS) has proposed a new rule that would implement the discharge planning requirements contained within the Improving Medicare Post-Acute Care Transformation Act of 2014 Impact Act. The goal of this act was to improve consumer transparency and beneficiary experience. CMS expects the new rule to give influence to the Impact Act as well as modernize the discharge planning requirements by bringing them into close alignment with current practice. Additionally, the new rule is to help improve patient quality of care and outcomes while reducing avoidable complications, adverse events and readmissions.

There are three specific parts of the proposed rule that will directly impact the daily work for all case managers and social workers:

  • Development of a discharge plan within 24 hours of patient admission and completion of the discharge plan prior to discharge
  • All inpatient, certain types of outpatient, observation, surgery/same day procedures where anesthesia/moderate sedation is used, Emergency Department patients identified by a practitioner
  • Follow up process to ensure quality of post-acute services

In order to comply with the above requirements case managers and social workers will have more patients to assess. Additionally, the assessments will need to be more detailed to facilitate discharge plans based on individual patient/family goals, preferences and needs. Patients/family will need to be asked as to what they expect as their outcome, what their discharge needs are and what post-acute services they want to use. Once the assessment is completed, patient/family participation is obtained, and the discharge plan implemented, documentation in the medical record describing the plan is the next step. The final step in the discharge plan is follow up with the patient/family regarding the quality of post-acute care services. CMS and Department Administrator Chief Medical Officer, Patrick Conway, MD, MSc states that this new rule will keep the patient and their caregivers at the center of care delivery. This process will give way to better care, smarter spending and healthier people.

Cathy Massaro