Q&A: Patient choice in discharge planning

Q. How many discharge plan options should case managers provide to patients during the discharge planning process?

A. No rule or regulation appears to state specifically how many choices patients must receive during the discharge planning process. However, many hospitals have policies regarding the number of choices to give Medicare patients, and many discharge planners suggest a minimum of three choices. This ensures a backup choice if the first choice becomes unavailable. Regardless, the requirement to provide appropriate choices supersedes any requirement, self-imposed or otherwise, to provide a specific number.

In some situations, only one provider may be capable of meeting a patient’s clinical, geographic, and level-of-care needs; in this case, providing a choice about only one is appropriate. Reassure patients that the single selection is in their best interest by:

• Assessing their needs
• Speaking with and counseling them during the process
• Informing them and their families that there has been a concerted effort to locate the appropriate
• provider for their postacute care needs
• Working with their physicians and other team members

Appropriateness of the discharge should drive the referral even when the choice of one happens to be a provider that the hospital owns. For example, providing a choice of three when only one or two are appropriate can create a dilemma for patients who choose one that is not appropriate.

For more information, see Discharge Planning Guide: Tools for Compliance, Fourth Edition.

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