Purpose of this Blog

The purpose of this blog is show that CMS needs to give clearer direction on roles for discharge planning which will reduce readmission rates. Without clear federal mandate, hospitals may struggle with which skill set should direct the initiative to reduce admissions, especially drug abusers readmits. Significant financial penalties for high readmits rates may occur, thereby causing a financial crisis.

Hospitals have to find a way to reduce readmissions, especially for those patients who have substance abuse problems. Drug abusers are usually readmitted because they have overdosed. While there do not appear to be current studies on readmission rates for substance abusers, older studies show that heroin users have high readmission rates. Those studies, coupled with current newsworthy events, like “A Call to Arms in Vermont as Town Tackles a Heroin Epidemic” , (New York Times, February 28, 2014) show that this is a small crisis that could loom large if we don’t tackle the problem now. But can we address this crisis by assigning ownership and oversight for discharging these readmitted patients to nursing, not to social workers, not to case managers, and not to any other skill set. Nurses are the best solution to, and should be held accountable for this readmission problem.

Deborah Stone said it best: institutional reform has several variations: “changing the membership of the voters and the citizenry; 2. Changing the leadership; 3. Centralizing or decentralizing authority; 4.changing mechanism of accountability;…”
I don’t think the federal government or nursing and social work associations have kept up with published studies’ general consensus that the nursing profession should be assigned the lead role in discharge planning. Indeed, while social work is a valuable resource in this effort, I recommend that the nursing profession is better equipped to address quality outcomes, coordinate the following of the patient’s medical care through the post-acute system and reduce readmission rates.

Once nursing has established their discharge planning role, it should be their responsibility to establish a redundancy system. Educate and mentor social workers so that, in the event nursing is not available, social workers can pick up the responsibility, but with eventual reporting on system/process problems in discharge planning, especially patients with substance abuse. Drug abuse is a relapse disease and discharge plans are critical in the success of a drug users’ ability to fight this disease.

Let’s touch on redundancy, ownership, collectiveness and accountability: I think hospitals have recognized through this strategic planning on readmits rates that this is a time of unparalleled challenge. Today’s health care shift presents us with a challenge not just to our system but to my own Hospital community. We need to have a broader frame, with nursing leadership setting the stage for mutual understanding on how to proceed, including an understanding that today’s leadership is now necessarily collective. So, where a nurse can have oversight but educate and pass the baton to a social worker, we gain knowledge and ownership, which gains accountability. That is, where ownership works well, personal stakes advance and evoke accountability; ownership aligns self-interest with collective interest and energizes personal and organizational learning.

Generally speaking, if a hospital has high readmissions in a short period of time, payers might think there is a lack of coordination between skilled staff during the discharge planning process. Payers like Medicare and Medicaid are constantly searching for new ways to improve the quality of care provided to their patients and to lower costs associated with that care. The Centers for Medicare and Medicaid Services (CMS) have recently issued a warning to hospitals to develop a strategy to reduce readmissions, especially in the 7-30 day time period, or suffer decreased federal and state reimbursement. Hospitals around the country are trying to develop new ways to reduce readmissions by implementing stronger discharge planning, lest they suffer from CMS’ financial penalties.

I think there is a way to reduce drug users’ readmissions to hospital by developing the skill set of nursing to oversee the discharge planning process which includes giving patients better instructions, coordinating after care planning and following the patient after discharge with after-care appointment in out-patient rehabilitation clinics for drug abusers.

The problem is that CMS has not given clear definition on which skill set should be responsible for discharge planning.

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