Discharge Planning: A Review of Strategies for Improving Your Practice and Maintaining Compliance

Discharge planning has become more than just the movement of the patient out of the hospital. It is a “process” that starts at the point of admission and follows beyond discharge and through the continuum of care. The Centers for Medicare and Medicaid Services have proposed more “teeth” to the process, with updates to the discharge planning section of the Conditions of Participation. 

This program will review the most recent reimbursement challenges from the Medicare program as well as strategies for safely transitioning your patients across the continuum of care. Effective discharge plans can improve your hospital’s value-based reimbursement. 

We will review how to engage other members of the interdisciplinary care team in the process of planning for the patient’s movement across the continuum including verbal and written hand-off communication. Discharge planning is no longer a destination but a process! Learn how to be certain that your processes address the complexities of the new healthcare environment.

Learning Objectives:

• Understand discharge planning as a process not an outcome
• Discuss the new CMS changes related to transitional and discharge planning and how they can impact your practice
• Identify best practice strategies for transitioning patients across the continuum of care
• Transitional planning as a process
• CMS’s transitional care management services
• Case management transitions
• Role of RN case manager and social work case manager in discharge planning
• The admission assessment role in the discharge plan
• Triggers for social work consults in complex discharge planning
• Supportive case management roles for discharge planning: perioperative case manage, complex discharge planning case manager, case management assistant
• Influences on transitional planning
• Discharge planning compliance
• Proposed changes for Conditions of Participation: discharge planning from CMS
• Communicating across the continuum of care
• The interdisciplinary impact on transitional planning
• The outcomes dashboard for discharge planning

Who Will Benefit:

• Directors of Case Management
• RN Case Managers
• Social Work Case Managers
• Directors of Finance
• Directors of Social Work
• Physician Advisors
• Chief Medical Officers
• Any Executive Responsible for Case Management