Home Health Care Policies: Discharge Planning Proposed Rule Focuses on Patient Preferences

Today, the Centers for Medicare & Medicaid Services (CMS) 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, must meet in order to participate in the Medicare and Medicaid programs. The proposed changes would modernize the discharge planning requirements by: bringing them into closer alignment with current practice; helping to improve patient quality of care and outcomes; and reducing avoidable complications, adverse events, and readmissions.
  
The proposed rule would also implement the discharge planning requirements of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), which will improve consumer transparency and beneficiary experience during the discharge planning process. 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.  

“CMS is proposing a simple but key change that will make it easier for people to take charge of their own health care. If this policy is adopted, individuals will be asked what’s most important to them as they choose the next step in their care – whether it is a nursing home or home care,” said CMS Acting Administrator Andy Slavitt. “Policies like this put real meaning behind the words consumer-centered health care.”

Improved Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies:  
As called for in 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 each applicable patient . Under the proposed rule, hospitals and critical access hospitals would be required to develop a discharge plan within 24 hours of admission or registration and complete a discharge plan before the patient is discharged home or transferred to another facility. This would 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. In addition, hospitals, critical access hospitals, and home health agencies would have to --

• Provide discharge instructions to patients who are discharged home (proposed for hospitals and critical access hospitals only);
• Have a medication reconciliation process with the goal of improving patient safety by enhancing medication management (proposed for hospitals and critical access hospitals only);
• For patients who are transferred to another facility, send specific medical information to the receiving facility; and
• Establish a post-discharge follow-up process (proposed for hospitals and critical access hospitals only).

Increased Patient Participation in the Discharge Planning Process:
The proposed rule emphasizes the importance of the patient’s goals and preferences during the discharge planning process. These improvements should better prepare patients and their caregivers to be active partners for their anticipated health and community support needs upon discharge from the hospital or post-acute care setting. 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.

In addition, patients and their caregivers would be better prepared to select a high quality post-acute care provider, since hospitals, critical access hospitals, and home health agencies would be required to use and share data, including data on quality  and resource use measures. This results in the meaningful involvement of patients and their caregivers in the discharge planning process.

“This rule puts the patient and their caregivers at the center of care delivery,” said CMS Deputy Administrator and Chief Medical Officer Patrick Conway, M.D., MSc. “Patients will receive discharge instructions, based on their goals and preferences, that clearly communicate what medications and other follow-up is needed after discharge, and pertinent medical information will be communicated to providers who care for the patient after discharge. This leads to better care, smarter spending, and healthier people.”