Time to Shine a Light on the Discharge Process

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)

Home care services help patients after hospital dischargeIt looks like we’ll be seeing significant changes in discharge decision making over the next few years, thanks to CMS’s effort to reduce post-acute care costs.

Late last year, Kaiser Health News reported on this endeavor, noting that one out of every six 2012 Medicare dollars went to patients in rehab facilities, nursing homes, long-term care hospitals or their own homes. After discovering major discrepancies in spending, CMS is focusing on potential over-use and fraud in some parts of the country.

In many ways, this is good news. Hospitals often discharge patients based on which facility has beds, with little consideration of the type of facility where they would receive the best care or which facility type might be cost-effective. Shining a light on this process would be good for the industry overall and could lead to cost savings.

Of course, the danger for home health agencies is getting “lumped in” with more expensive forms of post-acute care. Agency executives will need to proactively share data on how cost-effective home health services are compared with other acute care providers.

The article uses an example from the Medicare Payment Advisory Commission showing that Medicare’s cost for treating a stroke patient, including time in the hospital and three months of subsequent care, averages $40,000 if the patient is discharged to an inpatient rehabilitation facility, $33,000 if discharged to a nursing home and $13,000 for a patient cared for at home with the assistance of health aides.

In addition to financial illustrations, home health executives can arm themselves with evidence on home care’s benefits to patients, hospitals and the healthcare system, including personalized care, lower readmission rates and better outcomes. As hospitals are pressured to change the way they look at patient discharge, they’ll need current, correct information on all their options.

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