September 3rd, 2013
Big changes in health care make headlines. Except when they slip by unnoticed. A memorandum earlier this year from CMS’s Center for Clinical Standards and Quality/Survey & Certification Group to state survey agency directors fits this category. As if the agency’s title weren’t wordy enough, the subject of the memo, issued on May 17, would hardly excite the average reader, even one familiar with health policy: “Revision to State Operations Manual (SOM), Hospital Appendix A—Interpretive Guidelines for 42 CFR 482.43, Discharge Planning.”
The contents of the 39-page memo, however, are what count. The specificity and comprehensiveness of the guidelines have elevated the standards for discharge planning under the Conditions of Participation in Medicare and Medicaid from a familiar but often undervalued set of activities to a major responsibility that surveyors will review for compliance.
The revised guidelines set out clear expectations for hospitals to take discharge planning seriously by, among other actions, assigning trained professionals to the task, involving patients and families (or “representatives” or “support persons”) at every stage, and ensuring that appropriate training and referrals to community services have been completed. The guidelines also emphasize that hospitals must know the capabilities and capacities of post-discharge facilities and communicate effectively with them. When implemented by hospitals and monitored by state survey agencies, these changes will go a long way toward improving transitions in care for patients and their family caregivers and reducing hospital readmissions. Cost savings should follow.Read the rest of this entry »