Healthcare News & Insights

CMS proposes new discharge planning rule

If you haven’t evaluated how your facility handles the discharge process in a while, get ready to do it soon. A new proposed rule from the Centers for Medicare & Medicaid Services (CMS) will require hospitals to make discharge planning more patient-focused. 

ThinkstockPhotos-486140536The proposed rule, published in the Federal Register, specifically addresses the discharge process and improvements hospitals need to make.

CMS created the new guidelines as part of its ongoing quest to improve quality of care and reduce the likelihood of readmission.

Involved patients

According to a press release, the driving force behind these new guidelines is the well-being of the patient. After the proposed rule passes, all hospitals will be required to specifically consider patients’ goals and preferences for treatment and care during discharge.

CMS wants hospitals to involve patients more closely in the discharge process because, per the Federal Register notice, “patients and their caregivers frequently are not meaningfully involved in the discharge planning process.” That means they’re unable to:

  • name their diagnoses
  • list their medications, the purpose of these medications or the side-effects
  • explain their follow-up care plan, or
  • express their treatment preferences and goals of care.

Without a clear understanding of these areas during the discharge process, patients are more likely to experience complications while recovering, including early readmission.

Hospitals’ responsibilities

To make sure patients’ needs are taken care of, CMS wants hospitals to use patients’ preferences and care goals to create a comprehensive discharge plan.

The plan must take each patient’s individual needs into account. This not only includes issues directly related to patients’ conditions (e.g., availability of primary care providers for follow-up visits), but other factors such as how easily the patient can access critical nonhealthcare services (e.g., stable housing).

Specifically, hospitals must:

  • provide discharge instructions to patients who are discharged to their homes
  • have a specific medication reconciliation process designed to improve the patient’s medication management
  • send specific, relevant medical information to facilities patients are discharged to, and
  • create a post-discharge follow-up process.

CMS also wants hospitals to form closer partnerships with community organizations offering services to patients – particularly those designed for patients with psychiatric and behavioral health problems, including substance abuse. This way, facilities can best direct patients to a variety of resources to meet their needs post-discharge.

The goal of this collaboration is to promote a sense of teamwork between hospitals, patients and community groups to improve patient care – something CMS says is lacking. Better teamwork along the continuum of care leads to better outcomes after leaving the hospital.

Speaking up

Once the discharge-planning rule is implemented, hospitals must meet the new requirements if they want to remain eligible to receive Medicare and Medicaid.

Hospitals can check out all the guidelines, including detailed examples of what CMS wants to add to the discharge process, on the Federal Register. The rule is up for comment until Jan. 4, and facilities can weigh in on the proposal (and make suggestions for improvement) by visiting

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