Q&A: Preadmission and case management

September 13, 2017
Medicare Web

Q: How can my case management staff be proactive when it comes to preadmissions?

A: Preadmission refers to planned admissions while the ED manages emergencies that are not planned. Both may lead to hospital admissions and involve conversations with patients, families, and providers prior to the patient settling in a bed. Case management can be proactive by informing patients of options and rights that can influence efficiency, quality of care, and patient satisfaction and decrease LOS and readmissions. Case managers assess the patient and determine a tentative discharge plan by gathering information from the patient and his or her support person prior to admission. This may include asking about prior hospitalizations for behavioral health treatment or whether the patient has been diagnosed with a developmental disability, so that if the Preadmission Screening and Resident Review (PASARR) screen is positive, a referral for a Level II evaluation can be made as soon as possible to avoid discharge delays.

When working with patients and their families prior to a planned hospital admission, the case manager must know the patient’s payer source or insurance plan and should review the benefits with the patient and family. The patient should identify his or her preferred discharge plan and at least one backup plan in case the preferred plan is not possible. After assessing the patient, determining the supports and resources available to him or her, and hearing the patient’s preferred discharge plan, the case manager should discuss options with the patient and family—preparing the patient for any plan variances—and should then develop a tentative discharge plan.

For more information, see the Case Management Patient Communication Toolkit.

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