CMS just changed the rules for discharge planning -- and star ratings may matter more
Medicare's newest rules may prompt home care providers to work a little harder on their performance ratings to boost referrals this winter.
New Conditions of Participation are being revised to make sure information about treatment goals will follow a patient between health care settings -- from facilities to home health and then on to any other post-acute care setting when the patient is discharged from home care.
The Centers for Medicare and Medicaid Services (CMS) wants facilities and agencies to use that information about patient goals and help patients check out provider performance data to better match patients with the next health care setting.
New requirements were spelled out in a final rule posted Sept. 30 to the Federal Register in a move CMS administrator Seema Verma said will “put patients in the driver’s seat, playing an active role in their care transitions to ensure seamless coordination of care.”
Starting Nov. 29, the discharge process at facilities and home health agencies must focus on the patient’s goals and treatment preferences, with specific documentation required. The new process puts the burden on hospitals and other facilities to refer patients to home care providers best matching the patient’s documented goals and preferences. Compatibility between provider and patient will be determined by looking at key performance data, according to J'non Griffin, Owner and President of Home Health Solutions.
“The new rule requires a facility’s care team to work with patients, their families or representatives to select home health agencies or other post-acute care providers based on key performance data that is relevant and applicable to the patient’s goals and preferences,” J'non said.
Home health agencies, too
In the same way that facility care teams will be expected to use performance data to find appropriate home care providers for a patient, home care providers will be expected to match patient goals with services and performance metrics when they send the patient to another post-acute care provider such as a skilled nursing facility, in-patient rehabilitation facility or long-term care hospital.
“This means home health agencies will need to work with patients and their caregivers to select a good match in a post-acute care provider by using and sharing data that includes quality measures and resource use measures,” J’non said.
“And the data used to make that referral must be relevant and applicable to the patient’s documented goals of care and treatment preferences.”
Documentation will be more important than ever under the new rule, according to J’non.
“CMS has said it expects providers to document all efforts regarding these requirements in the patient’s medical record,” J’non said.
Some of the requirements in the rule aren’t new. Facilities and home health agencies are already required to send specific medical information when patients are transferred to another facility or care provider.
Under new Conditions of Participation for Medicare effective since 2018, agencies must complete an informational discharge or transfer summary within specific timeframes even when the discharge or transfer was not expected.
But the new discharge planning rule revises certain sections of the CoPs to add specific new requirements about including patient goals and preferences, and considering those patient goals when assisting patients during the transition to a different health care setting.
The revisions are an additional move by CMS to meet the mandate of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014.
“The Impact Act was designed to standardize and improve health care across all post-acute care segments in incremental stages, and this latest rule impacting discharge planning is one more way that we’re seeing that happen,” J’non said. Improve your star ratings
Want to improve your agency's star ratings in preparation for performance data sharing under new discharge planning requirements? Home Health Solutions can help!
We're featuring a complete, QAPI-compliant Performance Improvement Project in our online store for just $9.99, and it focuses on improving star ratings. The project is outlined in a step-by-step framework, complete with interventions, and is provided in WORD format so that your agency can easily tailor it with your specific information. Use it as is or use it as a model to build additional PIPs.
We'll even include a complimentary link to a recording of our recent webinar, "Driving a 5-Star Rating Through QAPI." Click here to visit the store now!