MedPAC considers giving hospital discharge planners bigger role in placing nursing home residents

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MedPAC's meeting included talk of allowing hospital discharge planners to recommend PAC providers to patients.
MedPAC's meeting included talk of allowing hospital discharge planners to recommend PAC providers to patients.

Almost half of skilled nursing facility residents had five or more higher-quality facilities available in their area that they were not directed to by a discharging hospital, a federal panel shared last week.

While just under 15% of nursing home residents were discharged to the facility with the highest quality rating within a 15-mile radius, almost half (46.8%) went to facilities that were outscored in quality ratings by five or more providers within that radius, the Medicare Payment Advisory Commission said during a meeting on discharge planning held Thursday. “Non-trivial” is the way the quality gap was described between many of the facilities in question.

Motivating hospitals and patients to choose higher-quality long-term care providers could benefit patients' care outcomes — and lower costs and reduce readmissions for the Medicare program, MedPAC panel members said.

But discharge planners currently are limited by rule as to how they can educate or steer patients on their post-acute options, critics complain.

MedPAC recommended modifying discharge planning rules to allow hospitals to recommend specific nursing home and home health providers — a practice that's already allowed in the Comprehensive Care for Joint Replacement program.

The group also discussed the possibility of having discharge planners openly consider post-acute providers' quality ratings when developing discharge plans, and offering quality data to patients prior to discharge.

That process could be nudged along by offering financial incentives to both acute and post-acute providers, possibly by expanding the Hospital Readmissions Reduction Program to cover more conditions.

MedPAC also proposed expanding post-acute value-based purchasing to include home health agencies.

MedPAC members said they are in favor of the changes, as there is “real demand from beneficiaries to get guidance” on their post-acute card options, Bloomberg BNA reported.