Inpatient Facility Coding & Compliance Alert

You will need to conform to CMS standards, and share quality data.

Give way, for your patients will steer their own discharge plans in the times to come. CMS has proposed to revise the discharge planning requirements that hospitals, including long-term care hospitals and inpatient rehabilitation facilities, critical access hospitals, and home health agencies, in a press release dated Oct. 29.

“This is part of outcomes management in healthcare which has come into and out of vogue from time-to-time,” says Duane C. Abbey, PhD, president of Abbey and Abbey Consultants Inc., in Ames, IA. “To me it makes sense because we should assess what the patient wants or expects.”

Read on to know more on how exactly this is to take shape.

Background: The IMPACT Act requires hospitals, critical access hospitals, and certain post-acute care providers to use data on both quality and resource use measures to assist patients during the discharge planning process, while taking into account the patient’s goals of care and treatment preferences. With these proposed changes, CMS aims to bring the requirements in closer alignment with current practice; improve patient quality of care and outcomes; and reduce avoidable complications, adverse events, and readmissions.

The requirements: According to the IMPACT Act, hospitals, including inpatient rehabilitation facilities and long-term care hospitals, critical access hospitals, and home health agencies would be required to:

• Develop a discharge plan based on the goals, preferences, and needs of the patient
• Discharge plan within 24 hours of admission or registration
• Complete a discharge plan before the patient is discharged home or transferred

Apply to all inpatients and certain types of outpatients, including patients receiving observation services, patients who are undergoing surgery or other same-day procedures where anesthesia or moderate sedation is used, and emergency department patients who have been identified by a practitioner as needing a discharge plan.

Hospitals and critical access hospitals would be required to consider several factors when evaluating a patient’s discharge needs, including but not limited to the availability of non-health care services and community-based providers that may be available to patients post-discharge.

“Two patients with the same condition may have very different outcome objectives,” opines Abbey. “Also, there can be two patients with the same conditions, but one has caregivers that can handle post-acute care while the other patient does not.”

What’s more: The proposed rule will also empower patients and their caregivers to be better prepared to select a high quality post-acute care provider, since hospitals would be required to share data on quality and resource use measures.

The cost: “I am not sure that there will be increased cost per se,” admits Abbey. “But there will need to be education for both physicians and hospitals. Depending on how this process is implemented, physicians and case management will have to reorient their thinking to some extent.”

For further details go to https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-27840.pdf . This document is scheduled to be published in the Federal Register on 11/03/2015.There is a 60 day comment period for this proposed rule.