“Avoidable Days”—hospital days in which the patient is medically stable for discharge but there is a barrier that prolongs the patient’s hospital stay—was the focus of WHA’s second Post-Acute Conference held September 6 in Wisconsin Dells. “Challenges in Post-Acute Care: Discharging Complex Hospital Patients” attracted 150 participants representing a diverse spectrum of professionals involved in post-acute care from hospital, nursing facility, and home health settings, as well as Department of Health Services and Family Care Managed Care Organizations.
Keynote speaker Dr. Josh Luke, founder of the Readmission Prevention Collaborative, described how value-based purchasing has changed the incentives in selecting post-acute care options and challenged the audience to incorporate a “home first” orientation when looking at post-acute care options for patients. This approach is incorporated into Dr. Luke’s Discharge with Dignity Guide. While home discharge is not appropriate for all patients, the guide encourages doctors and hospitals to consider sending a patient home with resources—as opposed to an institution—to age, heal and recover. The guide illustrates which discharge destination (ranging on a continuum from home to long-term acute care hospital) is most appropriate given the patient’s condition, the monetary costs to the patient, and financial penalties for hospitals and doctors if patients are consistently discharged from the hospital to post-acute institutions.
Following the keynote, six breakout sessions explored topics including Family Care MCO case management for hospitalized members; how county nursing homes serve complex patients discharged from the hospital; how health systems track avoidable days; hospital complex patient review committees; and how guardianship can be expedited to facilitate placement of patients into post-acute settings.
The diversity of providers represented both on the panels and in the audience provided an opportunity for exchanging ideas and increasing understanding of what role each type of provider plays in ensuring appropriate, quality care for complex patients in acute and post-acute settings.