Hospital Discharge Coordination Improves Workflows and Outcomes

By Nicole Usher, Sr. Director of Operations, Apricus, an Enlyte company
Two of the most persistent problems plaguing workers’ compensation payers have 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; however, severity has increased, and medical lost time claim severity has grown more than twice as fast as medical price inflation over the last 20 years.
NCCI also concluded almost half of workers’ compensation claims resulted in medical expenses of $10,000 - $500,000. With higher-cost claims occurring more often and accounting for a larger share of spending, we can assume a decent percentage will require a hospital admission, and it is highly probable they will require multiple products and specialty services post-discharge from the hospital to initiate recovery efforts. These injured employees will require discharge coordination to make their transitions timely, cost effective, and more successful for all parties involved.
To accomplish this hospital discharge coordination can play an integral role in a successful transition from hospital to home or facility, making this move as safe and easy as possible. Without this appropriate care and support, numerous factors can complicate recovery.
Without a plan in place to support a successful transition, the injured employee could be compromised, potentially resulting in a readmission or delay in recovery or return to work. Additionally, the employee may become frustrated with the situation. Case managers and adjusters may also be burdened with scattered details resulting in time delays and avoidable expenses including costly additional days in the hospital.
What to Look for in a Hospital Discharge Program
Nearly three-quarters of hospital discharge referrals are requests for same or next day, so having a care coordinator that is available 365/24/7 with national provider coverage for all services is essential in getting the process started any time of day or night.
For the most complicated medical conditions, discharge planning should be structured using a team approach. While the doctor may authorize a patient's release from the hospital, a social worker, nurse, discharge coordinator, or case manager will likely need to work in conjunction with a host of other medical professionals to complete the process, which could include DME and other medical supplies, transportation, home health, home modification, and prescription drug coordination just to name a few.
By utilizing a care coordinator as your single source to facilitate all products and services the injured employee will receive required items and the burden of coordinating multiple requirements will be lifted off the adjuster. A successful program coordinator will also utilize a proactive, well-organized discharge transition plan so it’s not overwhelming for the injured employee or create additional work for the adjuster.
A discharge program care coordinator should collaborate with other parties, secure products and services in a timely manner, and be highly skilled in understanding the complexities of workers’ compensation cases. They must be able to manage the coordination, scheduling, and follow-up of multiple products and services from various sources for a multitude of injury types. Additionally, look for a program that can coordinate complex and catastrophic cases with multiple parties including specialty providers, adjusters, case managers, injured employees, and their families.
When evaluating the effectiveness of a hospital discharge planning program look for one that offers an initial plan outline, provides ongoing communication, as well as cost transparency. A clinical, patient-centric process should be in place to deliver optimal outcomes, cost savings, and superior service. It should also include digital strategies that streamline the process, provide full visibility, and ensure nothing falls through the cracks, and if issues arise, everyone should be kept in the loop to avoid surprises.
Early coordination ultimately involves getting an injured employee home utilizing multiple resources, but each party has their own goals for achieving this. The facility discharge nurse is looking for time savings and the identification of experts to provide needed products and services. The adjuster and case manager are also looking for similar things, as well as cost savings and determination of appropriate requirements. When a discharge care coordinator is included in this process all parties can focus on their goals and feel confident that the facilitation of appropriate products and services are being managed for them. This ensures the injured employee’s goals for a smooth transition with reduced stress for themselves and their family are accomplished. With planned coordination this process is more efficient, and each party achieves their goals as a team.
About the Author
Nicole Usher has 15 years of experience in the workers’ comp industry and has held multiple leadership positions. As an operational leader, Nicole promotes innovative ways to provide superior client experiences that adhere to the complex nature of the industry, state regulations, and the needs of claims professionals.
She is also the author of a three-part series on hospital discharge planning, of which the above piece is a synopsis from part one. To read more from the series on how hospital discharge planning can improve workflows and outcomes, visit: www.apricusinc.com/hospital-discharge-planning.

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