Key Points:

  • Foundation of effective transitional planning
  • Current rules, regulation, and standards for transitional planning
  • Preparing for a CMS survey with the Conditions of Participation for discharge planning
  • Barriers to effective discharge planning
  • Case Management department strategies for effective discharge planning
  • Physician collaboration with discharge and transitional planning
  • Multidisciplinary rounds
  • Readmission impact of ineffective discharge planning
  • Sample dashboard metrics

Improving Care Transitions: Discharge Planning from Admission to Community Transfer


Discharge planning has become more than just the movement of the patient out of the hospital.  It is a “process” that starts at the point of admission and follows through to the community and the post-acute care providers. The Center for Medicare and Medicaid Services has specific requirements for this process. This program will review those requirements. It will also discuss the challenges hospitals are facing as they assume more risk some of the new payment models, such as bundled payments. Strategies for safely transitioning your patients across the continuum of care will be discussed. In addition, we will review how to engage other members of the interdisciplinary care team in the process of planning for the patient’s movement across the continuum including verbal and written hand-off communication. Transitional planning is no longer a destination but a process! Learn how to align with next level of care providers and ensure that your processes address the complexities of the new healthcare environment.

Why Should You Attend?

Planning for the transition, both in the hospital and out of the hospital has progressed over the past several years. Case management professionals, both RN case managers and social workers now must understand the required processes, as well as understand how transition delays may put the hospital at risk for loss of revenue and patients at risk for negative events. This session will integrate the previous session webinars to assimilate the discharge planning process with other case management roles and functions. New case managers and social workers must have this information to understand the strategies presented which can help ensure they are contributing to optimal department outcomes.

Session Highlights:
  • Understand transitional planning as a process not an outcome
  • Discuss compliance to discharge and transitional planning rules and regulations
  • Identify the best ways to transition patients across the continuum of care
Who Should Attend:
  • Director of Case Management
  • RN Case Managers
  • Director of Finance
  • Director of Social Work
  • Social Workers
  • Hospitalists
  • Physician Advisors
  • Director of Nursing
  • Chief Medical Officers
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Recorded $ 213.00
Transcript $ 213.00
DVD $ 223.00
Recorded + Transcript $ 343.00
DVD + Recorded $ 353.00
DVD + Transcript $ 353.00
Total $ 0.00

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