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Patients discharged on Fridays likely admitted
In an article entitled "Data Analysis Exercise: Beware of 'Friday's Child,'" that appeared in "Home Care Automation Report" on October 31, 2006, Tim Rowan reported on a presentation at the most recent National Association of Home Care (NAHC) meeting by Jeff Lewis from Lewis Computer Systems in Baton Rouge, LA. Based on his research, Mr. Lewis was able to present conclusive data that patients discharged from hospitals to home care on Fridays are significantly more likely to be rehospitalized within a week than patients discharged on other days of the week.
Of course, the reasons for this disparity remain unclear. One explanation could be that hospital discharge planners/case managers are too anxious to discharge as many patients as possible before the weekend so that patients are going home who really do not belong there yet. Regardless of the explanation, this data spells potential trouble for hospital discharge planners/case managers.
Conditions of Participation (COP's) of the Medicare Program for hospitals include requirements related to discharge planning. Specifically, these COP's make it clear that hospital discharge planners/case manager must assess and evaluate patients for discharge planning purposes. They are also required to develop and implement appropriate discharge plans.
If patients whose plans of care include home health services are rehospitalized within a week, and in view of the disparities described above, patients and/or their family members may claim that hospital discharge planners/case managers were negligent. Specifically, according to national standards of care in Medicare COP's as described above, discharge planners/case managers have a duty to develop and implement appropriate discharge plans. They may be liable if they breach this duty and cause injury or damage to patients.
From a practical point of view, it is easy to imagine and cringe at the way in which attorneys for patients and their families may use data that shows that patients discharged with home care services on Fridays were more likely to require rehospitalization later. Juries are likely to conclude that discharge planners were just too eager to "clear the decks" before the weekend to the detriment of patients!
Based upon this data and potential liability, discharge planners must be very careful on Fridays with regard to referrals for home health services. At a minimum, this means that they must be certain that the following criteria of appropriateness for home care services are met:
When one of more of these criteria are not met, discharge planners are on "thin ice" with regard to managing their risks of legal liability.
In addition to the above criteria, discharge planners/case managers must be sure to communicate complete, accurate information to post-acute providers. The tendency on Fridays may be to rush to get as many patients discharged as possible to the detriment of the planning process, including communication of crucial information to post-acute providers. Home heatlh agencies, private duty agencies, hospices and home medical equipment (HME) companies should also be quite concerned about this data.
From a practical point of view, patients sent home "too quick, too sick," as the old cliché says, are risky for home health agencies to accept. When discharge plans are inappropriate and lawsuits result, post acute providers may be drawn into these lawsuits despite the fact that the basic problem was breach of duty by case managers/discharge planners.
In addition, the quality of home health service is already evaluated, in part, based on rates of rehospitalization of agencies' patients. This quality indicator is likely to become more crucial when pay for performance (P4P) is implemented because agencies' reimbursement will depend on low rates of rehospitalization. At least at this point, rehospitalization rates are one of the indicators which will be used to determine agencies' reimbursement from the Medicare Program. A viable strategy for agencies to use to lower rates of rehospitalization may be to decline to accept patients on Fridays.
Consequently, it is clearly in the best interests of both discharge planners and post acute providers to further consider this disparity in rehospitalization rates and to work together to reduce this rate in order to manage risks and maintain reimbursement rates that support financial viability. The real "bottom line," is that patients should not be sent home on Fridays who really do not belong there and who are more likely to experience deterioration in their conditions that puts them back in hospitals. This result is unacceptable to everyone.