In October 2015, the Centers for Medicare & Medicaid Services (CMS) embarked on a major reform to review and introduce new regulations to the discharge planning requirements that all healthcare facilities, including critical care facilities, long-term care facilities, nursing home agencies, and inpatient rehabilitation hospitals, must observe in order to take part in the Medicare and Medicaid initiatives.
These new requirements will advance the discharge planning practices by aligning them closely with current practices; improving patient quality of care and outcomes; and lessening unnecessary complications, adverse outcomes, and readmissions (American Hospital Association, 2016). The new discharge planning requirements focus on increasing patient preferences during the discharge process and improving communication after the discharge. After nearly a year of consultation, the CMS is set to release the new requirements on November 2016 for all hospitals to review and rewrite new discharge guidelines for all inpatients and other cases of outpatients.
Internal policy changes
Kendall Regional Medical Center will have to make significant changes in its internal policy regarding discharge planning processes and procedures under the improved guidelines in the Medicare Conditions of Participation (CoPs). This implies that the Medical Center will have to review and comply with CoPs or else it would be “penalized or lose its right to bill for Medicaid and Medicare” (AHC Media, 2016, p. 1).
The Medical Center will have to expand its internal rules to account for new patient populations introduced in the discharge planning requirements. These discharge cases would include “long-term acute care, critical access, and inpatient rehabilitation” (AHC Media, 2016, p. 1). Further, internal policy changes would affect practices of case managers because they require discharge procedures for observation services patients, emergency department patients, and patients scheduled for same day surgery or other interventions that involve anesthesia and sedation.
Kendall Regional Medical Center would be required to provide standardized data with relevant contents on quality measures, other measures, and resource use according to Improving Medicare Post-acute Transformation Act of 2004 (IMPACT).
The new regulations emphasize collaboration. Nursing and medical personnel, as well as discharge planner and case managers will provide their inputs during the development of discharge planning policy (Gholizadeh, Delgoshaei, Gorji, Torani, & Janati, 2016). The hospital board will have to approve the new written discharge planning policy.
The influence on nursing procedures
The rule has introduced a clear difference between discharge instruction and patient education. That is, nurses, physicians, and/or case managers will educate patients about their conditions, as well as provide comprehensive, printed discharge instructions.
Previously, nurses had delegated discharge planning processes to care managers, although nurses conduct admission evaluation and determine patients’ needs more than other care providers do. The new rules will make discharge planning assessment a component of nurse job (AHC Media, 2016).
The Medical Center will have to identify possible discharge requirements for all patients within a day after admission and accomplish all processes before the discharge or transfer of a patient to a different hospital. Even if a patient takes less than 24 hours, the hospital must meet all discharge needs without any delays.
The Center will require a multidisciplinary team to engage in the discharge planning process, specifically in cases involving serious conditions, such as heart failure. The committee would identify the responsible physician, all other clinical personnel responsible for care provision, and support individuals for patients, including family members (Popejoy, 2011).
The Medical Center would focus on effective transitions and readmission reduction. Hence, it shall conduct both admission and discharge assessments on most patients or all patients if necessary. It will assume that all patients require discharge planning because of increased acuity in discharged patients.
The discharge plan would account for patients’ clinical needs, psychological support, and financial issues. Moreover, case managers would lead the process, identify skill set required, and engage the most appropriate personnel.
The new discharge planning rules provide for patient re-evaluation for possible discharge requirements during hospital stay, and case managers must continuously revise the plan to account for any changes based on patients’ conditions.
The influence on patient care
The new requirements emphasize the need for hospitals to have a discharge planning process to account for “patients’ objectives and preferences in the plan” (AHC Media, 2016, p. 1). They ensure that case managers or nurses prepare patients and caregivers appropriately to adhere to “the plan, offer managed transition to post-acute care, and strive to reduce readmissions during all these processes” (AHC Media, 2016, p. 1).
The Medical Center will have to evaluate the discharge planning process regularly and examine cases of patients readmitted within 30 days (American Hospital Association, 2016). It will focus on finding ways to improve discharge planning processes and ensure effective patient transition and communication (New, McDougall, & Scroggie, 2016).
The new requirements clarify that case managers must develop a discharge plan in consultation with patients. Moreover, the entire hospital team will have to take part in the discharge planning procedures. More important, nurses, medical staff, and case managers would engage patients and their caregivers in the planning process to ensure that they can provide the necessary care after patients’ discharge (Bankston-White & Birmingham, 2015). Care plan must account for patient preferences and goals.
Moreover, only qualified personnel, such as RNs or case managers, would coordinate discharge assessment. New rules emphasize that discharge planning assessment goes beyond case management to include admission assessment and review utilization, which directly involve nurses and physicians. As such, collaboration between nursing personnel and case managers will be vital to ensure that the Medical Center attains discharge planning assessment and requirements within 24 hours using standardized processes (Holland & Bowles, 2012).
Implementation of the change across Kendall Regional Medical Center
The new discharge planning rules affect the entire facility. As such, the implementation will affect all departments. The Medical Center will conduct a gap analysis to identify areas for further improvements and expectations of staff. It would perform readiness assessment to determine if all personnel are ready to embrace the new discharge planning rules. The Medical Center will also conduct a workflow analysis to determine areas for collaboration and all processes and procedures for effective adherence to the new rules. It shall develop an implementation plan to guide the implementation of the new discharge planning rules.
Conclusion
Kendall Regional Medical Center has acknowledged that the new discharge planning rules will solidify previous discharge planning practices and ensure robust, improved discharge processes for all patients while concentrating on quality of care and readmission reduction. As such, the Medical Center will have to review and change how it offers discharge planning to comply with the new requirements under the IMPACT Act.
It would review the entire discharge planning process to ensure improved processes and patient participation in the entire process. Overall, the Medical Center shall provide discharge instructions to patients, develop medical reconciliation processes, coordinate care with other receiving facilities, and develop a post-discharge follow-up process, and all staff members shall actively participate in all processes involved.
References
AHC Media. (2016). New discharge planning rules focus on preferences, transitions.
American Hospital Association. (2016). CMS Proposes Revisions to Discharge Planning Requirements.
Bankston-White, C., & Birmingham, J. (2015). Case Management Directors: How to Manage in a Transition-Focused World: Part 1. Professional Case Management, 20(2), 63–78..
Gholizadeh, M., Delgoshaei, B., Gorji, H. A., Torani, S., & Janati, A. (2016). Challenges in Patient Discharge Planning in the Health System of Iran: A Qualitative Study. Global Journal of Health Science, 8(6), 168-178.
Holland, D. E., & Bowles, K. H. (2012). Standardized Discharge Planning Assessments Impact on Patient Outcomes. Journal of Nursing Care Quality, 27(3), 200-8. .
New, P. W., McDougall, K. E., & Scroggie, C. P. (2016). Improving Discharge Planning Communication Between Hospitals and Patients. Internal Medicine Journal, 46(1), 57–62. Web.
Popejoy, L. L. (2011). Complexity of Family Caregiving and Discharge Planning. Journal of Family Nursing, 17(1), 61-81.