PATH ALONG 3 Day CMS Rule Has Expiration Date

The Centers for Medicare and Medicaid (CMS) have enacted policy to cause hospitals to commit to a higher level of care coordination in the community.  This pay source is using law to shape hospital service delivery.  Hospitals will form comprehensive connections with community providers to secure links of transition to demonstrate care assurance with the continuity of care role.

This converts planning discussion from the focus on patient behaviors to the importance of shaping the environment (clear path) to best meet the populations changing needs.  Structure of delivery systems are being challenged to update practise as a way to better serve the community members.

The community is understanding that a person must be severely ill to be admitted to the hospital today.  Recorded symptoms must demonstrate a defined level of severity before a person can be admitted to the hospital. 

Hospital staff confronted with a patient too sick to be sent home alone, but not severe enough to be admitted to the hospital will place the patient in observation status.  Observation status is an outpatient category that facilitates a stay in the hospital room with staff services.  This is a hospital provider using a strategy to try to keep this person safe. 

The difficulty in care coordination arises with the Centers for Medicare and Medicaid (CMS) 3 day rule.  CMS (pay source) requires the person to be admitted to a hospital for 3 days for Medicare and Medicaid to pay for post acute care or rehab services in a skilled nursing facility.   A stay in a hospital under observation status does not count toward the 3 day rule which would translate to access for service in a skilled nursing facility. 

To further complicate matters The Centers for Medicare and Medicaid utilization review may find the outpatient observational status stay improper and deny payment.  This results in the hospital claims department sending a bill for the hospital stay to the patient for private payment.  The confused patient feels blamed for a system delivery difficulty. 

The (CMS) Centers for Medicare and Medicaid take home message is the hospital staff need to form working relationships with community (www.homecarepath.com) service providers available to assist this person at home.  As the hospital commits to this new vision of continuity of care the 3 day rule becomes obselete. 

PATH ALONG is an original Wisconsin model that connects inpatient providers to community staff who support the patient during health system transitions.  Wisconsin's PATH ALONG is a bridge toward a hospital practise that reduces readmissions and improves community health.  Check out the site below with free access
http://www.homecarepath.com/Pages/PRESSRELEASEOriginalWisconsinModelToReduceHospitalReadmissionRates.aspx