Discharge Planning Advisor-Problems with SNFs? Seek out compromises
Discharge delays spark creative solutions
Hospitals facing discharge delays as a result of financial restrictions on skilled nursing facilities (SNFs) are well advised to seek out their own innovative solutions, suggests Edward Emnett, RN, CPHQ, manager of clinical resource management at South Florida Hospital in Plant City.
The SNFs are increasingly leery of accepting patients with complicated care needs because of the limited reimbursement they can expect under Medicare's new prospective payment system (PPS), Emnett notes. With that in mind, he says he is taking a proactive approach to enhancing the relationship between his hospital and the local nursing homes.
"I've done presentations on hospital discharge planning with the [skilled nursing] facility's staff, saying, 'We're in this together, we can be a team,'" Emnett adds. "This has gotten us over some of the humps."
One issue Emnett has addressed involves a form that the state Department of Children and Families requires hospitals to complete for patients who need admission to a SNF. "The state has done audits on this in some nursing homes, and [auditors] are not amused by SNFs accepting incomplete forms," he says.
His approach to the form problem, Emnett says, has been, "Tell me what you want, and I'll try to get it." The form requires documentation from several different disciplines, which is difficult to get in a timely fashion, he points out. "We still have physicians who come in that morning and decide they want to send the patient home at noon."
As a compromise, Emnett says, he suggested that instead of filling in every line of the complex form — as the nursing home previously required — the hospital staff attach a copy of the patient's history and physical and current medication sheet. Answers to problems often lie, he notes, in such "simple, practical stuff."
Emnett sets up regular meetings with SNF administrators, he says, and arranges in-services for their staffs. "This is nothing magic, just trying to go out and talk to people," he adds. "Most of us in resource management have not had to do that [before] in the community. To me, it seemed to be the only thing to do."
St. Joseph's Medical Center in Tampa, another hospital in the Baycare Health System, recently began hosting quarterly luncheon meetings with area nursing home administrators, Emnett says. "They set it up as a networking session, to deal with common problems. So far, the overall feeling has been positive."
Another idea Emnett is pursuing is sharing hospital educational programs with nursing homes. "When we look at diagnoses, we see patterns in the readmission of patients with congestive heart failure," he notes. "We're wondering if we go back and find out how many of these patients go to nursing homes, could we take the same educational program there? It might work [for both hospital and SNF] and tighten the relationship between the two."
[For more information, contact Edward Emnett, Patient Care Coordination Department, South Florida Hospital, 301 N. Alexander St., Plant City, FL 33566. Telephone: (813) 757-1295.]
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