Home Health & Hospice Week

Home health agencies facing referral discrimination from a hospital should carefully weigh two choices when attempting to fix the problem.

If it's a simple oversight, the agency can make a friendly "marketing type" call to the hospital, request to get on its list and follow up to see that it has, advises attorney Elizabeth Pearson with Covington, KY-based Pearson & Bernard. After all, the Balanced Budget Act of 1997 requires hospitals to list only those HHAs that request it.

It's better and quicker to get things cleared up at the source if possible, points out Burtons-ville, MD-based attorney Elizabeth Hogue. Although Professional Home Care Inc. succeeded in bringing about a survey that should change Woodlawn Hospital's home care referral practices (see story, previous article), it took three months for a survey to occur after submitting a complaint letter, and another month for a plan of correction to be accepted. In the end, Professional is closing its doors May 6 despite the regulatory victory that is too little, too late.

And an attempt to speak to the hospital first lends credibility to a later complaint, Hogue adds.

But if a hospital is blatantly flouting home care referral laws and undermining an HHA, confronting the hospital is likely to do more harm than good, Pearson advises. "If you start snooping too much you can get blackballed," she warns, and many agencies still rely on the meager referrals the hospital sends their way.

Instead, with the weight of this survey precedent behind them, HHAs should seriously consider lodging a complaint with the state survey agency, Pearson urges. The process is anonymous, so the complaint could appear to come from another HHA in the area, a referral source, a patient or anyone, Pearson points out.

Providers also can report violations to the Joint Commission on Accreditation of Healthcare Organizations, suggests Hogue. When CMS finalizes a new regulatory provision on home care referrals proposed last November, JCAHO is likely to take a more active interest in compliance with the mandate. JCAHO accredits and surveys about 80 percent of Medicare-certified hospitals, CMS says.

HHAs also can go to CMS' regional or central offices with their grievances, Hogue says.

If HHAs do decide to make a complaint, they should be prepared to furnish specific examples and actions, Pearson counsels. "They should have their ducks in a row," she exhorts. If an agency weighs in with vague beefs against a hospital, "it will sound like sour grapes."

Providers should obtain signed statements from patients whenever possible, Hogue recommends. "This is not always easy to accomplish," Hogue admits, "but with a little effort and over time, the agency will be able to get a statement from a relative of an employee, a member of the agency's Board of Directors, etc."

But HHAs should avoid pressuring patients and families to furnish statements or squabbling over patients with other agencies, Hogue stresses.

Professional Home Care owner and administrator Lori Crispen provided a list of concrete examples along with statements from staff members and other health care professionals who witnessed some of the behaviors. That's probably a big reason why ISDH surveyors took the matter so seriously and acted on it, Pearson says.