The Importance of Hospital Discharge Planning in Workers’ Compensation

Hospital discharge planning is an integral part of the transition to a different facility or home. Without the appropriate care and support, numerous factors can complicate an injured employee’s recovery. A well-planned hospital discharge is vital in preventing re-admission, further health decline and increased health care costs. In part one of our three-part series, we will delve into:

  • Common workers’ compensation injuries that result in hospital admission
  • Frequency and severity of claims in the past decade
  • Making discharge planning easier with commonly ordered items
  • Attaining positive outcomes through successful planning

Trends Driving Increased Need for Discharge Planning

Two of the most persistent problems plaguing workers' compensation payers has been the severity and frequency of claims. The National Council on Compensation Insurance (NCCI) reported the frequency of claims has dropped an average of 3.9% per year while severity has increased. In addition, the NCCI notes that medical lost-time claim severity has grown more than twice as fast as medical price inflation over the last 20 years with much of that growth occurring in the early-to-mid 2000s.

A report from the U.S. Bureau of Labor Statistics (BLS) found four main causes of work injuries and illnesses that resulted in the employee having days away from work and going to a medical treatment facility:

  • Sprains, strains and tears; 1% resulted in hospital admission
  • Soreness and pain; 3% resulting in hospital admission
  • Fractures; 15% resulting in hospital admission
  • Cuts and lacerations; 5% resulted in hospital admission

NCCI researchers concluded almost half of workers' compensation claims result in medical expenses of $10,000 - $500,000. With higher-cost claims occurring more often and accounting for a larger share of spending, it is highly probable these injured employee claims will require multiple durable medical equipment (DME) products and other specialty services post-discharge from the hospital.

Understanding Hospital Discharge Planning

Discharge planning is defined as "a process that determines the kind of care needed after leaving the hospital. Discharge plans can help prevent future readmissions and should make the move from the hospital to home or another facility as safe and easy as possible."

While the doctor may authorize a patient's release from the hospital, a social worker, nurse, discharge coordinator or case manager will complete the process of discharge planning to assist the injured employee’s transition into the next steps in their recovery. Other people who may be involved when requested and when necessary, include the following:

  • Intake coordinator
  • Pharmacist
  • Occupational therapist
  • Psychiatric nurse
  • Physiotherapist
  • Speech therapist
  • Dietician

Ideally, especially for the most complicated medical conditions, discharge planning should be structured using a team approach. Post-admission discharge planning needs could include prescription drug coordination, DME and supplies, transportation, home health and home modification to name a few.

Services for Recovering at Home

Home health care is one element of a discharge plan that allows injured employees to recover in the comfort of their own home by providing a seamless transition of care from the hospital. The goal of the discharge coordinator will be to facilitate home health care services to:

  • Increase speed of recovery for the injured employee
  • Provide an extensive network of highly skilled professionals and knowledgeable staff
  • Offer customizable solutions with availability 24/7
  • Arrange home-health assessment
  • Decrease spend for workers' compensation payers

Home health care can include speech therapy, IV therapy, general and skilled nursing care, physical and occupational therapy, companions and homemakers. Additionally, solutions may include transitional housing, such as assisted living or Americans with Disabilities Act (ADA) residential with home health care.

The Benefits of a Discharge Plan

Without a plan in place to support a successful transition home, the injured employee's safety could be compromised and potentially result in the readmission or delay in recovery and return to work. Additionally, the injured employee may become frustrated with the situation. Case managers and adjusters will also become burdened with scattered details resulting in time delays and additional expenses including costly additional days in the hospital.

However, if a proactive, well-planned hospital discharge is provided the transition home does not need to overwhelm the injured employee or create additional workloads for the adjuster or case manager. By utilizing a single source for all discharge planning needs the injured employee receives needed services in a timely manner that the burden of coordination is lifted off of adjusters. For example, arranging home health providers may be beneficial to injured employees who require in-home care or changes to their daily lifestyles due to a workplace injury. Assistance with transportation services can aid the injured employee in getting where he or she needs to go such as to follow-up doctor’s visits that are needed for recovery. Facilitating DME providers can be helpful in obtaining the right goods and services the injured employee will need once he or she transitions home. In addition, pharmacy program coordination can ensure that all prescriptions ready when the injured employee leaves the hospital.

When planning for a successful hospital discharge, it is important to arrange the necessary equipment for the injured employee. Here is a list of commonly ordered items to consider:

  • Mobility devices (manual wheelchair, walker, cane, crutches)
  • Home health services (skilled nursing/home health aide, physical/occupations therapy)
  • Various Equipment (bedside commode, shower chair)
  • Supplies (under pads, catheters, gloves)

What to Look for in a Discharge Planning Program

To ensure a smooth transition for the injured employee, you need a hospital discharge planning program that takes charge and coordinates all products and services before the patient leaves the hospital. Nearly three-quarters of hospital discharge referrals come in same or next day, so having a program that is available 365/24/7 with national provider coverage for all services is essential in getting the process started no matter what the time of day or night. Additionally, look for a program that collaborates with case management and adjusters, has consistent ability to secure DME and home health services in a timely manner, has highly skilled professionals who understand the complexities of workers’ compensation cases, recovery and return to work. Your discharge planning program needs to have coordination of multiple products and services, including DME needs, nursing services, home modification and rehabilitation equipment. Lastly, look for a program that can coordinate complex and catastrophic cases with multiple parties including adjusters, case managers and the injured employee's family.

Finally, when evaluating the effectiveness of your hospital discharge planning program, ask these five questions:

  1. Are your needs being fulfilled in a timely manner?
  2. Is an initial plan being outlined, providing ongoing communication and cost transparency along the way?
  3. Is a clinical, patient-centric process in place to deliver optimal outcomes, cost savings and superior service?
  4. Are digital strategies used to streamline the process, provide full visibility and ensure nothing falls through the cracks?
  5. If issues arise, are all team members and the injured employee kept in the know to avoid surprises?

Positive Impacts of a Successful Discharge Planning Program

A single source discharge planner can provide early coordination for all parties involved to achieve a smooth discharge. Each party is trying to solve for getting the injured employee home safely but also has their own goals to achieve. The discharge planning nurse is looking for time savings and the identification of experts. The adjuster and case manager are also looking for similar things, as well as cost savings. All with the injured employee's goal in mind of wanting a smooth transition home with reduced stress for themselves and their family in the hopes of feeling better and getting back to life. With planned coordination this process is more efficient so each party can achieve their goals. If close to half of workers’ compensation cases have medical expenses ranging from $10,000 to $500,000, a decent percentage will experience a hospital admission. Injured employees discharged from the hospital will require coordination to make their transitions to home or a facility successful. The inclusion of hospital discharge planning can be easier, safer and more cost effective for all parties involved, including the injured employee, injured employee’s family, adjuster, case manager and work compensation payer.