Prospective payments and hospital discharge planners' roles

A study to determine the effects of the new prospective reimbursement method on the role of discharge planners in the acute care hospitals and their impressions of its impact on elderly patients. A mail survey questionnaire examined the task responsibilities of personnel providing discharge planning services to the elderly. The components of successful discharge plans and the frequency of obstacles to optimal discharge plans were also assessed. Findings, based on a 75.3 percent response rate from hospitals (hospital N = 58, individual respondent N = 235), revealed that social work appeared to be the predominant discipline conducting discharge planning activities in New York City hospitals. The prospective payment system has changed discharge planning task frequency and the time allocation of tasks, perceptions of inpatient populations, the need for case management and readmission rates. Family support was the strongest predictor for successful discharge plans cited by discharge planners while lack of interdisciplinary communication was a prime reason why discharge plans go awry. Discharge planners do not generally view their role as responsible for advising patients of the appeals mechanism. Professional discipline and the prospective payment system were the single most important independent variables to explain the variance among the areas of inquiry. Hospital auspice and bed size, and respondent's years of experience and employment tenure at their hospital were not very useful to explain differences. The comparison of nurses and social workers on performing parallel discharge planning functions showed that nurses tend to be more collaborative than social workers. One-third of the nurse and social worker respondents reported that their professional preparation was inadequate for discharge planning responsibilities and have recommendations for the curriculum of their respective professional schools.