Choice Does Exist Within Hospital Discharges

👍👎IS THERE FREEDOM OF CHOICE?

The good news is the law is on our side. The Centers for Medicare & Medicaid Services (CMS) rule CMS-3317-F details the specifics of the “discharge planning” process. The rule requires the process to focus on a patient’s goals and treatment preferences.

Essentially, the hospital cannot limit your options to their preferred facilities. They have to offer a list of qualified Medicare-certified vendors.

Will there always be options? I cannot guarantee that to hold for every situation, as geography and other elements may come into play. Will the options offer specifically what I or my loved one needs? Again, nothing is guaranteed, however, knowing the conversation does not have to end immediately is a positive.

For those using Medicare Advantage, some protections exist, but they might look different depending on your plan. Check with your plan before assuming the same rules apply.

👂I’VE BEEN THERE

I've experienced this scenario with my own mother, which is why I know the alternatives are real, even when no one hands them to you. Yes, you can go beyond the list you are given. The process is more manual than it should be, but it can be done.

My process started with reaching out to the insurance company to find a list of covered facilities. Then I went back to the care team to see if they had thoughts. Today I would ask if the hospital has relationships with any of the facilities and why. I ended up with more options than I was presented initially.

Your goal isn’t to be difficult with your questions or this additional work. Rather, you want to work with the care team to surface the best possible information to improve our loved one’s recovery.

Note: AI wasn’t available during my experience. I remind folks AI can help with research oriented tasks. (Always double check results though.) Use AI to research facility alternatives.

Take things one step further by creating a prompt asking AI to score or prioritize those alternatives on a numerical scale corresponding to the factors or gaps experienced at the previous rehab facility.

The result aren’t meant to replace a phone call or visit, but you’ll have more information to help you prepare for any following conversations.

WHAT DOES THE LAW SAY?

Under Medicare’s payment system, hospitals receive a flat rate payment for each diagnosis. It doesn’t matter what services were provided, the rate remains the same. This means longer stays could cost the hospital more money than what is billed.

When the discharge planner shares a list of facilities, they are providing information that results from being part of the same hospital/care network, existing relationships, available beds, or other factors.

While those factors are important, they don’t automatically always mean the best fit for your loved one. Ask questions.

📋 YOUR THOUGHTS ABOUT HOSPITAL DISCHARGES

🗞️ NEWS TO NOTE

• What would your caregiving journey look like if federal legislation offered retirement compensation to unpaid caregivers? The Social Security Caregiver Credit Act, could provide that option. It would credit your years of unpaid caregiving towards Social Security benefits. Keep an eye on it.

• A new report states, 51% of respondents believe that employees “should have full control over their own health insurance choices.” Read more about the report results here.

🛠️TOOLS TO NAVIGATE OPTIONS FOR OLDER ADULTS

Bookmark the resources below in case your older loved ones experiences the hospital discharge process. Feel free to share them as well.

• Medicare Care Compare - Use this site to search and compare every Medicare-certified facility, home health agency, rehabilitation facility and hospice by zip code.

• Medicare Fast Appeals - This Fast Appeals site details how to appeal a hospital discharge decision.

• Center for Medicare Advocacy: Discharge Planning - To learn more about patient rights, appeal processes, and pitfalls, visit this site.

If you’d like a list questions to start your preparation for a Medicare related placement, reply to this issue and I’ll send it directly to you.