Home Health & Hospice Week

Can you meet the 2-day deadline for transfer summaries?

If you have the best discharge or transfer summary in the world, but it doesn’t meet the timeline set out in the new Conditions of Participation, you’ll still be out of compliance. And that means you could risk a host of repercussions ranging from alternative sanctions to Medicare termination.

In the CoPs final rule published in the Jan. 13 Federal Register, the Centers for Medicare & Medicaid Services finalizes its requirement for home health agencies to send a discharge summary to the patient’s primary care provider and a transfer summary to a facility accepting the patient (see CoP language, this page). The requirement is just one way the new CoPs emphasize the importance of care transitions for patients.

The new CoPs are based on “patient-centered goals … that involve smooth and comprehensive transitions in care,” notes consultant Anna Doyle with Laff Associates in Hilton Head, S.C. Provisions such as the discharge and transfer summary requirements aim to “improve care delivery in transition from acute to post-acute health care settings,” Doyle says.

Improving care transitions is one of the most important take-aways in the CoPs final rule, Doyle believes.

The discharge summary provision is going to be one of HHAs’ biggest challenges in this rule, warns William Dombi, VP for law with the National Association for Home Care & Hospice.

Painful Timeline

One of the provision’s biggest difficulties is the time frame, says consultant Pam Warmack with Clinic Connections in Ruston, La. HHAs will have five business days to send a discharge summary to the primary care provider and two business days to send a transfer summary to a facility.

That’s a big change, Warmack stresses. “Currently there is no defined timeline unless a state minimum standard imposes one and the discharge summary has only to be made available upon request,” she notes.

Commenters on the October 2014 proposed rule had a lot to say about the timeline, with many telling CMS how unreasonable it was. CMS floated a seven-calendar-day deadline for discharge and a two-calendar-day deadline for transfer summaries. Many commenters pushed for longer deadlines such as seven or 14 days, CMS notes in the final rule. Or no deadline at all.

But HHAs didn’t get much relief. CMS allowed the use of business days rather than calendar days, but that’s the only concession. “Both transfer and discharge summaries are important for care continuity and transitions,” the rule stresses. “We believe that 2 business days for a transfer summary and 5 business days for discharge summary are appropriate maximum standards.”

In fact, CMS would like you to be even quicker than that. “Transfer summaries prepared and sent on the day of transfer, and discharge summaries prepared and sent in 2 calendar days after discharge are ideal, and we strongly encourage all HHAs to meet these timeframes,” CMS says. Consider the twoand five-day requirement a “maximum” timeframe.

However: “We understand that this may not be feasible in all transfer and discharge situations,” CMS allows.

Some Transfer Concessions

In the final rule, CMS does give providers a bit of leeway in the deadline by adjusting when the clock may start. “HHAs may not know that a patient was transferred to a facility for several days after that transfer has occurred,” commenters told CMS.

“We understand the commenters’ concerns regarding the issues surrounding an unplanned transfer to a facility, and agree that it would be difficult for the HHA to comply with the requirements if it was not aware that the transfer had occurred,” CMS responds in the final rule. “Therefore, we have amended the regulatory requirement … to require that the HHA sends a completed transfer summary within 2 business days of becoming aware of an unplanned transfer, only if the patient is still receiving care in the receiving health care facility at the time when the HHA becomes aware of the unplanned transfer.”

This revision should strike “an appropriate balance between sharing information, when such sharing has the potential to be helpful because the patient is still under the care of the inpatient provider, and conserving HHA resources when the patient has been admitted and discharged from the inpatient care provider before the HHA is even aware of the situation,” CMS continues.

This is good news, because “frequently, HHAs do not know a patient transferred to an inpatient facility until they are seen on a routine visit and the patient/caregiver tells the clinician the patient had been in the hospital,” says Judy Adams with Adams Home Care Consulting in Durham, N.C. “Obviously, the transfer summary, intended to provide coordination during a transition from one level of care to another, is not very useful after the patient returns home again.”

But don’t get too used to this exception. “In the future, as the use of interoperable health records becomes widespread in the HHA industry, we may consider a shorter timeframe for sending a transfer summary ... to make the information exchange more timely and relevant to patient care,” CMS cautions.

On the other hand, CMS doesn’t grant commenters’ wishes to eliminate transfer summaries for all emergent care situations, or any time a patient is admitted to the hospital.

One less thing: CMS also shoots down suggestions to require HHAs to give their discharge and transfer summaries directly to the patient. Other new CoPs requiring communication with the patient should cover that area, and the summaries would likely be overly technical for many patients, CMS responds.