The PDPM guidance recommends that discharge planning begin prior to admission for the Medicare A stay in a Post-Acute Care setting. The per diem adjusted rate under PDPM encourages early discharge planning to reduce the length of stay. The per diem rate is reduced by day 4 for Non-Therapy Ancillary and by day 20 for PT and OT. The per diem rate for nursing and speech-language-pathology remains unchanged until discharge or after day 100. Because the negative outcomes of early discharge are well documented many facilities will choose to take the financial loss anticipating a better outcome for the patient in the long run.
There is still merit in planning for a timely discharge and most patients are eager to return to their previous setting. Discharge Planning can begin before the patient leaves the hospital and the Admissions Screener can purpose to collect that information. With the initial assessment by all disciplines in the rehab setting more valuable discharge information can be gathered. Therapists and Social Workers may well lead this endeavor as they spend longer periods of time with the patients.
Part of planning for PDPM implementation may in fact consider having a “Discharge Team” who focus on a format and process to assure that every patient is discharged at the right time to the right setting.