Discharge Planning

BREATHING LIFE INTO DISCHARGE PLANNING

By Alfred J. Chiplin, Jr.

SUMMARY

This article focuses on discharge planning across several care settings, each with its own legal framework It gives particular attention to the acute care hospital setting, noting the importance of the acute care hospital as a care setting from which discharge planning and transitions from one care setting to another most often spring.

In addition, the article examines the discharge planning requirements of the Medicare statute in some detail. It identifies two principle Medicare-related short-comings: (1) the failure of the Medicare statute and its implementing regulations to give specific guidance about the responsibilities and duties for discharge plan implementation as patients move from care setting to care setting and (2) the lack of vigorous oversight and monitoring of discharge planning as a condition of participation in the Medicare program.

Strategies for improvement are also offered, embracing a variety of approaches. They include strengthening the Medicare statutory framework so that it is more specific about care transitions and responsibilities, including payment; working with the Medicare agency in expanding program oversight and guidance; looking to state laws as a basis for expanding beneficiary rights to discharge planning and transitions services; and building upon the dynamic research about the importance of care transitions, both as to clinical standards and better patient outcomes, and expanding patient and family education opportunities.

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