Q&A: Discharge Planning for CAHs

Q. What are the requirements for critical access hospitals (CAH) in relation to the latest proposed Conditions of Participation for discharge planning?

A. A CAH is a rural hospital and it’s one that is located geographically distant to a tertiary care hospital or a larger acute care hospital. In the past, CAHs were not required to do such rigorous discharge planning, but now Medicare has said CAHs have to do discharge planning for inpatients. Now, remember they're distinguishing between a discharge to home and a transfer to another hospital. The CAH average length of stay is about 72–90 hours. For those patients who go home directly from an inpatient stay at a CAH, the CAH is required to do the same as acute care hospitals. They have to have a plan for all patients and they also have to have a plan for follow-up for patients who are sent back into the community and not transferred to the hospital.

CAHs have been off the radar screen for a long time. They provide access to critical services in rural areas. Some health systems have CAHs as their related partners so that staff in an acute care hospital need to work closely with a CAH to help them understand the discharge planning requirements. If there is a CAH in your health system, develop a combined process for follow-up care.

This question was adapted from the HCPro webcast "Discharge Planning: Realignment of Standards and Workflow" featuring Jackie Birmingham, RN, BSN, MS, CMAC, and Janet L. Blondo, MSW, LCSW-C, LICSW, CMAC, ACM, CCM, C-ASWCM, ACSW.

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