Discharge Planning Advisor-Discharge planning got boost from HMOs?
Hospitals started becoming aware of the importance of discharge planning to their operations with the establishment in the early 1980s of the Medicare prospective payment system, says Donald B. White, spokes man for the Washington, DC-based American Association of Health Plans. But it was only when HMOs emerged as major deliverers of health care, he suggests, that discharge planning received serious emphasis.
"In health care, as in most areas of life, things happen when there's a financial reason, or motive, for them to happen," White says. "Before, there was a lot of talk about discharge planning, but in whose best interest was it to do discharge planning? Was it in the best interest of the physicians? No. The insurance companies did have a vested interest, but — with rare exceptions — they didn't get involved with the delivery of health care."
Those who criticize insurance plans for their emphasis on short lengths of stay, he says, overlook the attention that is given to post-discharge care. Citing his own experience with abdominal surgeries 30 years apart, White says follow-up care today is far superior than with the fee-for-service insurance he had in the past.
"Thirty years ago, I could have used home visits," he adds. "It didn't have to do with money, but with having someone think about what the course of treatment should be."
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