LHCR / Home Health Newsletters

March 2008

DISCHARGE TO THE COMMUNITY

Discharge to the Community is a Utilization Outcome, encompassing M0100 and M0870.  It relates to the use of health care services resulting from a change in patient health status.  

Discharge to independent living is the primary goal of home health care for the majority of patients.  In most cases, it is an indicator that the patient’s condition has improved to the extent that services are no longer needed.  Conversely, discharge to an inpatient facility is an indication for decline in health status.  

The measure is calculated using both outcomes and you want points added to your scores to increase your rates.  For example, you would receive a value of one if you answer number 9 (discharge from agency) for M0100 (reason for assessment) and you answer number 1 (patient remained in community) for M0870 (discharge disposition).  Other answers will not give you points.  Exclusions include patients where response to M0870 (discharge disposition) is unknown, patients who are non-responsive at SOC and patients whose episodes end with death. 

Some clarifications that may be helpful include: 

• Patients who are in assisted living or boarding houses are considered living in community.

• An actual patient interaction is required to complete the comprehensive patient assessment for a patient’s discharge from agency, unless patient was discharged in conjunction with an inpatient transfer or death at home.  However, under special circumstances when a discharge visit isn’t done, such as unexpected discharge following physician visit, information from the last qualifying visit (gathered by a clinician qualified to conduct assessment) may be used to complete the discharge assessment.

• Check with your agency’s policy which will state whether or not a patient is discharged when transferred to an inpatient facility for 24 hours or longer for reasons other than diagnostic tests.

• If patient is being transferred to an inpatient facility (with or without agency discharge), it is critical to obtain accurate information explaining what happened with the patient to cause the transfer.  This may include verifying with the facility or the patient’s family the exact type of admit (inpatient, outpatient, observation, etc.).

Proper and consistent assessment is important in managing your patient’s health status.  We can provide you with the tools to improve performance and increase efficiency while still providing patient centered care.  For additional intervention tools, click here to view RESOURCES and download LHCR developed brochures and posters that may be useful for in-servicing staff on the importance of consistent assessment.