MedPAC mulls bigger role for hospital discharge planners

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Hospitals can’t direct patients to specific nursing homes. MedPAC suggests changing that.
Hospitals can’t direct patients to specific nursing homes. MedPAC suggests changing that.

Hospital discharge planners may get more flexibility in placing nursing home residents under ideas being considered by the Medicare Payment Advisory Commission.

Almost half of skilled nursing residents had five or more higher-quality facilities available in their area that they were not directed to by their hospital, MedPAC members said at their early September meeting. Just under 15% of residents were discharged to the facility with the highest quality rating within a 15-mile radius, panel members shared. That's compared to the 46.8% of residents that may have missed out on going to a higher-rated quality provider.

Encouraging patients to choose higher-quality long-term care facilities could boost care outcomes while lowering costs and readmissions, but discharge planners are currently limited on how they can steer patients on options, the group noted. 

Among the ideas proposed to remedy that issue is changing discharge planning rules to allow hospitals to recommend specific post-acute providers, a practice already allowed in the joint replacement bundled payment model.

MedPAC also discussed having discharge planners consider post-acute providers' quality ratings when developing plans, and offering quality data, such as the information found on Nursing Home Compare, to patients prior to discharge. 

Also on the table are ideas to give financial incentives to both acute and post-acute providers who discharge patients to higher-quality facilities, such as expanding the Hospital Readmissions Reduction Program to cover more conditions. 

The ideas were expected to be narrowed down at future meetings.