Providing patient choice for post-acute care

The patient’s right to choose is one of the most basic patient rights. When it comes to discharge planning, Medicare rules require hospitals to involve the patient in the process. They also must give patients a choice between the available and appropriate post-acute services (e.g., home health agencies and skilled nursing facilities).

According to the Conditions of Participation for Hospitals in Section 482.43:

(7) The hospital, as part of the discharge planning process, must inform the patient or the patient’s family of their freedom to choose among participating Medicare providers of posthospital care services and must, when possible, respect patient and family preferences when they are expressed.

The concept seems straightforward, but many readers have recently been asking for additional clarification on the following issues:

• Documenting that the hospital provided post-acute discharge options to the patient
• Whether to include options that are off-plan
• Whether it is necessary to give choices to patients that are admitted from a nursing home they are satisfied with
• Whether it is appropriate to advise a patient on which facility to choose
• How many options the hospital should provide

Jackie Birmingham, RN, MS, vice president of Curaspan Health Group and author of HCPro’s Discharge Planning Guide,  answered two reader-submitted questions for the Case Management Weekly e-newsletter on the topic. The following are Birmingham’s responses:

• Q&A: Providing post-acute choices to Medicare Advantage members
• Q&A: Documenting patients’ post-acute choices