Hospital Discharges Need Team Planning for Best Results, Expert Says

Sarasota, FL (WorkersCompensation.com) – The hospital discharge for an injured worker may seem like a welcome development, but without proper planning it can turn into an expensive nightmare.  There are a plethora of issues that must be arranged long before an injured worker ends his hospital stay. 

“Without a plan to support a successful transition home, the injured worker may not be in a position to care for himself at home,” said Lisa Woolston, Account Relations manager for Apricus. “The worker might need transportation to and from appointments; safety could be a compromised, possibly resulting in readmissions or delays in recovery and return-to-work; injured workers s could become frustrated with the situation; case managers and adjusters will become burdened with scatter details resulting in time delays and additional expenses. So it’s best to be proactive vs. reactive whenever possible.”

In fact, Woolston says the best time to plan a hospital discharge is as soon as stakeholders know the injured worker will be going into the hospital, such as when surgery is first scheduled. During a recent webinar she explored the logistics and costs involved in hospital discharges for injured workers and the various planning aspects that can make for a smooth transition.

Claims and Costs

While the frequency of occupational injuries has decreased nearly every year of the decade, severity has been on the rise. In fact, the cost of injuries has increased more than twice as fast as medical price inflation in the last 20 years.

The top three causes responsible for 85 percent of total workplace injuries between 2006 and 2017 were overexertion; contact with object; and falls, slips and trips. The incident rates of the first two have declined as a percentage of injuries in recent years; while the ‘falls, slips and trips’ category has been on the rise. 

While claims with lower costs may be medical-only and require little if any ancillary services, higher priced claims have been on the increase. For example, claims up to $50,000 may involve some lost time and perhaps will need physical or occupational therapy.

Claims in the $50,000 to $100,000 range might include outpatient surgery and there might be some durable medical equipment such as canes and walkers.  Claims in the $100,000 to $500,000 range often involve major surgeries and will require even more DME. A majority of claims cost between $10,000 and $500,000.

“If more than half of workers’ compensation cases run from $10k - $500k, a decent percentage will experience a hospital admission,” Woolston said. “Injured workers discharged from a hospital will require a certain amount of coordination making their transitions home successful.” 

Items to Consider 

Medications, DME supplies, transportation, and home health and/or home modifications are among the many needs that may be involved in the transition from a hospital to home or another medical facility. But many of the commonly ordered items required are not clear cut and need preplanning. 

“For example, when there is a prescription for a medication it’s black and white – the medication, the amount to take and how to take it,” Woolston said. “But with a prescription for a walker, what do you think we see? You might see tennis balls, slides, brakes; do we need something that’s heavy duty … it’s very gray in a DME world.” 

An injured worker discharged with a wound infection may incur costs of between $5,000 and $7,500 in the 30 days after release. In addition to the supplies to treat the wound, there may be dressings, bandages and ointments that must be ordered. A stronger IV medication may be needed. Special bedding, such as a pressure mattress may be needed to help heal the wound.

A claim involving a quadriplegic may require various nursing – such as skilled nursing, registered and/or LPNs, a certified nursing assistant and a home health aide. Occupational and/or physical therapy may be needed, along with oxygen if the person is on a ventilator and incontinence supplies. Home modifications may also be needed, such as ramps, and handrails. The cost 30-days post discharge can easily exceed $10,000 to $15,000, Woolston said.

Discharge Planning

While some organizations have developed recommendations for discharge planning, there is no universally used system in U.S. hospitals. The need for such planning is becoming more ever more important.

“Patients are released from hospitals quicker and sicker than in the past, making it even more crucial to arrange for good care after release,” Woolston said. “When does discharge occur? Friday afternoons or before a holiday. Usually a PA writes the script because the doctor has already gone for the day. That’s why it’s best to be proactive whenever possible.”

Discharges are authorized by medical providers, but a variety of people can and should be involved with the plan itself, Woolston said. The goals of home healthcare solutions should be to decrease spend, increase speed of recovery, have an extensive network of highly skilled professionals, have a knowledgeable staff, customizable solution and availability 24/7. There needs to be collaboration with case manager and adjusters and an understanding of workers’ compensation. “This removes the guesswork plus provides a simple and easy process,” Woolston said. “We always want a smooth transition and to try to eliminate any additional expenses [such] as an extra day in a hospital or facilities.”

It’s important to plan for home health. You need a prescription to dispense this item,” Woolston said. “Even before COVID we had a shortage of home healthy care and it’s not increasing due to COVID ad is especially noticeable in the rural areas. So it’s important to plan.”

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