Compliance is mandatory, but data from CMS remains unavailable at this time.

The discharge planning day of reckoning is today, Black Friday, Nov. 29, 2019 – and yet, as of this reporting, the only source of data, the Centers for Medicare & Medicaid Services (CMS) Compare website, still has no skilled nursing facility (SNF) resource use data.

According to Ronald Hirsch, MD, there is another flaw in the final rule that has yet to be rectified. One of the required data elements is resource use.

“If the patient requires inpatient rehabilitation facility (IRF) care or long-term acute care hospitalization (LTACH), the only way for the patient to access that data is either by having the patient or family go online and look at the data on the website, or print out the data for each facility individually,” Hirsch said during his appearance on Monitor Mondays this past Monday. “The website does have a feature that allows you to compare three facilities side by side, but if you print that out, the resource use data does not appear. What does this mean? If you are a Chicago hospital and your patient needs inpatient rehab, you would need to print out 100 pages to provide the patient all the information they are required to receive.”

This situation has led Hirsch to conclude that the only way to meet this requirement is electronically, noting that there are several vendors that have solutions, some of which are free. But hospitals can also refer patients and their families to the CMS websites.

“The pages can be viewed on a phone, but it takes a lot of scrolling,” Hirsch cautioned. “For those who do not have a laptop, perhaps your IT department can buy a few $99 Chromebooks or tablets for use by patients, checking with your infection control departments to ensure you don’t spread pathogens.”

Since most communities have a number of SNFs, and even more have home care agencies, hospitals might want to provide a printed list that simply indicates the star ratings to at least allow the patient to narrow down their choices.

“And remember,” Hirsch added, “you can also indicate any facilities that offer special expertise or meet specific cultural needs. You must indicate any SNFs or home health agencies where the hospital has a financial interest, and you cannot designate any as preferred.”

When CMS was contacted about a possible delay in enforcement, a representative reported that to their knowledge there are no plans for such, adding that sub-regulatory guidance is not expected until spring, 2020. Hirsch remarked that since the surveyors do not have updated survey guidelines from CMS, it would be difficult for them to survey a facility and cite them based on the new regulation.

“But that should not stop every hospital from updating their discharge planning policies and doing their best to comply,” Hirsch added. “Compliance is not optional.”  

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