After discharge from a hospital or a SNF, patients could potentially enter any number of post-acute care settings, or go home. The Post Acute Destinations/Discharge Metrics (PAD) tables, which can be found on any Hospital or SNF detail page, show the number of patients discharged (discharge events) from the identified source and the status coding for post-acute care from those discharge claims. The columns in the table include patient counts and performance metrics related to the patient discharge instructions and subsequent patient care, while each row represents a different type of post-acute care destination.
Mastery of The PAD table will increase your understanding of the challenges faced by discharge planners and case managers, so you are better prepared to become a trusted adviser and influence how they approach patients during discharge.
Understanding the Data
Each care setting at a hospital or SNF has its own PAD table. For instance, a general acute care hospital has a PAD table for both Inpatient and Outpatient. A SNF will have a PAD Table for Outpatient and SNF. The separate tables allow you to isolate how a particular setting is managing discharge.
The PAD table contains rows for the primary post acute settings as shown below. See the article How are Facility Discharge Instruction Codes Determined? for additional details on the specific codes we use from the claim to determine the discharge coding.
The following image is from an Inpatient PAD Table. The images of the Post Acute Destinations/Discharge Metrics table in this article have been enhanced to make understanding easier. As you compare these images to the Solution, you will notice that the abbreviations have been expanded and headers have been added here.
The columns within the PAD Table have three distinct sections:
- Discharge Coding and Care Received - This section shows the count of patients coded for discharge to each type of post-acute care, the count of those patients who received the matching care within 30 days, and the count of those patients who received the care irrespective of discharge coding. Metrics in the later sections pertain to patients receiving care at the setting within 30 days irrespective of discharge coding. Patients receiving care in multiple post-acute settings within 30 days of discharge are included in counts for all care settings.
- % Readmitted: 30 days (Inpatient Only)- This section includes Readmission rates with benchmarks against the county and state for each post-acute care setting. For more on readmission and hospitalization, see % Readmission, % Hospitalization, and 30 days.
- 30 Day Mortality (Inpatient and SNF) - This section includes Mortality rates with benchmarks against the county and state for each post-acute care setting. 30 Day Mortality is defined as the percentage of the patients that entered the post-acute care setting and died within 30 days of discharge.
The Outpatient PAD table only includes the section, "Discharge Coding and Care Received." with three columns of metrics.
For more information about the entry, "other, see: What is "other?"
New Episode/Resumption of Episode
In the Home Health Solution, PAD tables we include three rows of metrics that track discharges to Home Health Care. Once we determine the "counts" for each column, reflected in the row, "Inpatient to Home Health Care (Total)," we then separate those counts into two categories differentiated by whether the subsequent episode of care is a new episode or a resumption of care. A billing episode is considered a resumption of care if the care is provided as a continuation of a prior billing episode. If there was no prior home health care provided, the episode is considered new.
In the image above, the two metrics in the box will always be empty. Even though the discharge claim identifies post-acute status at the time of discharge, there is nothing on the discharge claim to identify whether the subsequent Home Health Care will be a new episode or a resumption of care.
Using the PAD Table
Although the optimal approach to discharge will vary from hospital to hospital based on their patient population and the hospital's strategy to support it, analyzing the hospital's approach to discharge can identify areas of opportunity. Sometimes the hospital itself hasn't performed this analysis and sharing it with them positions you as a value added partner for them! Questions you can answer include:
- What is the hospital's rate of discharge coding to a post-acute setting and how does it compare to national and state averages?
- What is the patients' rate of adherence to discharge instructions and how does it compare to national and state averages?
- How many and what percent of patients are entering a post-acute setting without being coded to do so?
The diagram below depicts the discharge process from a coding, adherence, and admission perspective using an example of 100 patients. The green arrows represent the patient flows where an increase would likely result in more patients being admitted to hospice. Creating conversations about these flows, may help you discover an opportunity to support the hospital's goals AND increase the flow of patients to your agency. Specifically the opportunities are:
- Increase the number of patients that are coded for your care setting.
- Increase the number of patients that adhere to their discharge instructions.
- Increase the number of patients that enter your care setting shortly after discharge regardless of the discharge instructions.
Higher than average % Readmitted: 30 days or 30 Day Mortality rates may point to an opportunity to increase the use of hospice for terminal patients. Hospice patients are much less likely to be readmitted to the hospital and the palliative care they receive can lead to a longer life span as well. In particular, readmission penalties are a substantial motivator for the hospital. If you can show that alternative care settings have higher than normal mortality rates, higher than normal readmission rates, and hospice has a lower than normal utilization rate, then you can make a strong case for better promotion of hospice during the course of care and discharge at the hospital!