Star Ratings and Discharge Planners: Data in Patient’s Hands
- Christopher Leonard, DO, MHI
- December 4, 2019
A major change in hospital discharge and post-acute referrals occurred on November 29th. Hospitals and case managers are now required to provide patients with information that assists them in making informed decisions about who provides their post-care. This change has tremendous implications for how patients are directed upon discharge and where they go after the acute stay.
In the rule recently published by Medicare, it states Medicare is implementing:
“[D]ischarge planning requirements which will give patients, and their families access to information that will help them to make informed decisions about their post-acute care, while addressing their goals of care and treatment preferences, which may ultimately reduce their chances of being re-hospitalized.”
The move from handing out a list of facility names to now providing data and helping patients determine which facility will best meet their needs is very significant. In fact, an entire market of software tools has been created and marketed to hospital discharge planners and hospitals to use in highlighting certain home health and skilled nursing providers over others.
Previously because of concerns over violating anti-steering regulations, hospitals did not provide any detailed information or even attempt to help patients choose their post-discharge provider. Now hospitals are required as a condition to participate in the Medicare program with assisting patients. Medicare does caution providers that they must not steer patients to specific providers but must inform patients they have a choice in providers.
Medicare expects that discharge planners will help patients consider and interpret Nursing Home Compare data as it pertains to selecting how to meet individual goals.:
“Providers should use these data sources to assist patients as they choose a PAC provider that aligns with the patient’s goals of care and treatment preferences, and we would also expect providers to document all efforts regarding this requirement in the patient’s medical record.”
The quality reporting program (QRP) and the focus on functional status, skin integrity, falls, and resource use are the basis for ranking providers and information provided to patients.
This data on how a facility performs in its QRPs will not only impact the discussion discharge planners have with patients and families, but ultimately referrals.
Medicare allows and encourages hospitals to provide patients with additional information and data to select a PAC provider. These materials can even include marking material or other information from PAC providers:
“so long as the information presented aligns with the patient’s goals of care and treatment preferences.”
Hospitals must now help patients suffering from various conditions, including wounds, find the right PAC provider for them. Currently, the indicator of wound care quality as reported in QRP, is the percentage of short-stay residents who have new or worsened pressure ulcers. In fiscal year 2020, this measure will be replaced with the “Changes in Skin Integrity Post-Acute Care: Pressure Ulcer/Injury measure.” This updated measure is important because it will include new or worse unstageable pressure ulcers and deep tissue injuries (DTI). Facilities will no longer exclude these from their reporting. The measure will report each stay and will not use an “episodes” of care (an episode can include multiple stays while counting just a single episode).
To differentiate and improve referrals within a local community PAC providers will need to provide quality care in a variety of areas and highlight success to potential patients. Wounds are of significant importance for both Skilled Nursing Facilities and Home Health Providers. Several actions can be taken to improve the local community standing and to help patients, through hospital discharge planners, make informed decisions for their care.
Vohra Wound Care has been helping our partners differentiate themselves in the market, and we independently verify and certify superior clinical quality.
Vohra created the Center of Excellence for Wound Management program to recognize and certify PAC providers. Providers achieving excellence have committed to staffing with certified wound care nurses, maintaining wound-related hospitalizations of less than one percent and partnering with physician wound experts. With the changes hospitals now look at Medicare data and at other sources to present information to help patients decide the best PAC facility for their care. A Vohra certified Center of Excellence for Wound Management is an example of additional information that Medicare finds aligns perfectly with meeting the patient’s goals for care and treatment.
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