The complex case discharge delay problem © 2021 Healthcare Association of New York State, Inc. THE COMPLEX CASE DISCHARGE DELAY PROBLEM Acknowledgments HANYS thanks members of its complex case discharge delays workgroup for their guidance in developing this white paper. Kelly Degonza, RN Sheryl Mersten, RN, BSN CONTINUUM OF CARE SPECIALIST, DIRECTOR, CASE MANAGEMENT AND SOCIAL WORK, ALBANY MEDICAL CENTER JAMAICA HOSPITAL MEDICAL CENTER Deborah House, LMSW, CCM, ACHP-SW, CCI Kenneth Thayer, RN, BSN DIRECTOR, SOCIAL SERVICES AND CARE MANAGEMENT, ASSOCIATE VICE PRESIDENT, PATIENT CARE, ST. PETER’S HEALTH PARTNERS THE UNIVERSITY OF VERMONT HEALTH NETWORK - CHAMPLAIN VALLEY PHYSICIANS HOSPITAL Amanda Laprime, PhD, BCBA-D ASSISTANT PROFESSOR, PEDIATRICS, TRANSITIONAL MEDICINE, Mitchel F. Todd, MSW, LMSW DIVISION OF NEURODEVELOPMENTAL AND BEHAVIORAL PEDIATRICS, DIRECTOR, CASE MANAGEMENT AND UTILIZATION REVIEW, UNIVERSITY OF ROCHESTER MEDICAL CENTER ALBANY MEDICAL CENTER Lorna Manning, MHM, MBA, ACM-RN Alan Wilmarth, CASAC ASSISTANT VICE PRESIDENT, INTEGRATED CASE ADMINISTRATIVE DIRECTOR, BEHAVIORAL HEALTH, MANAGEMENT AND POPULATION HEALTH, UNITED HEALTH SERVICES HOSPITALS, INC. ST. JOHN'S EPISCOPAL HOSPITAL Questions? Sarah DuVall, MPH, CPHQ, Director, Behavioral Health
[email protected] Victoria Aufiero, Esq., Senior Director, Insurance, Managed Care and Behavioral Health
[email protected] © 2021 Healthcare Association of New York State, Inc. THE COMPLEX CASE DISCHARGE DELAY PROBLEM Table of contents 1 Executive summary 3 Background 6 Gaps in the care continuum 7 A system design flaw 11 Attempts to address the challenge 13 Next steps 14 Real examples of common scenarios 17 References © 2021 Healthcare Association of New York State, Inc. 3 THE COMPLEX CASE DISCHARGE DELAY PROBLEM Our system of care has a design flaw — it is primarily designed for people with a clear path, for those who do not have complex care needs upon discharge.