Assessing the Discharge Planning Process – Essential for Compliance and Reimbursement

Does your facility accept Medicare and Medicaid? For the majority of hospitals across the country, the answer is “yes”, requiring compliance with Medicare Conditions of Participation (CoP) for discharge planning. Discharge planning is not a new concept to hospitals, but recently, more detailed guidance combined with financial penalties associated with readmissions and quality of care should have hospitals assessing their discharge planning process. Effective discharge planning benefits both the patient and the hospital – improve patient satisfaction, reduce unnecessary readmissions, improve quality of care, educate patients, and determine appropriate care setting.

So, what is your facility doing to ensure effective discharge planning?

Hospitals should use the CoPs, interpretive guidelines and CMS Hospital Discharge Planning Worksheet used by surveyors to audit their discharge planning process. The audit should identify compliance with mandated requirements and opportunities to shift the hospital’s discharge planning process towards best practices using voluntary guidance in the interpretive guidelines. In order for your discharge planning to be effective, the process must go beyond basic policies and procedures. Hospitals need to ensure:

  • Policies and procedures are detailed to meet the various CoP requirements – For example, does your discharge planning policy include details on the process for ongoing reassessment of the discharge plan based on changes in the patient’s condition, changes in available support and/or changes in post-hospital care requirements? How do clinical teams execute this process
  • The discharge planning process is executed in accordance with the policies and procedures – Recommend interviews, observations and chart audit
  • All staff potentially involved in the discharge planning process are educated on the policies, procedures and processes and aware of the tools/resources available – Recommend annual and ongoing training

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