Home Health & Hospice Week

Know the 3 abandonment criteria that can land you in hot water.

If you're like most home health agencies these days, you are more likely to find yourself terminating services--and then facing the related risks.

Alert: The HHS Office of the Inspector General (OIG), the primary enforcer of fraud and abuse prohibitions, has specifically stated that abandonment of patients may amount to fraud.

At the same time, the list of reasons agencies might have for terminate a relationship with a client is growing," cautions Elizabeth Hogue, a healthcare attorney based in Burtonsville, MD.

She notes these top concerns:

• Reductions in reimbursement from many payers mean that providers have fewer resources to provide uncompensated care.

• Providers are increasingly aware of the possibility of professional liability when they continue to care for patients who are chronically noncompliant.

• Providers are also more aware of the possibility of violence against staff members.

All or nothing: To prove abandonment, patients and their families--and the OIG--must show the home health providers are guilty of all of the following, explains Hogue.

Specifically, a court may charge abandonment when a home health agency 1) unilaterally terminated the provider/patient relationship 2) without reasonable notice 3) when further attention was needed.

Initiate With Caution

If a patient takes the initiative in terminating a relationship with your home health agency, you are protected from any subsequent charge of abandonment, clarifies Hogue.

Problem: But since that's not always the case, be sure that you support any termination you initiate with a solid reason.

For instance, suppose you intend to terminate the relationship because your agency lacks resources to meet patients' needs. In this case, your actions could amount to "patient dumping" from the OIG's perspective.

Solution: If financial reasons keep you from admitting patients, be careful not to indicate that services are being discontinued because of changes in Medicare reimbursement or other payment related concerns."Rather, carefully explain that providers are not allowed to admit or continue services to patients if they lack the resources to meet their needs," says Hogue.

Alternative: Staff may also explain the inability to provide services based on staffing shortages, if true.

Staff must also emphasize that these are the sole reasons for the inability to continue services.

Time It Right

To ensure that you're giving a patient reasonable notice, call and document a team meeting for staff members involved in a patient's care, advises Hogue.

At the meeting, take into account all relevant factors in relation to the individual patient when making decisions about what constitutes a reasonable notice period.

Consider and carefully document, for example, what the patient wants, his clinical condition, his mental status, and the availability of alternative sources of care.

Essential: Tailor your determination of what's reasonable notice to the person.

General rule: A reasonable notice period, unless a specified period of notice is mandated by state statute or regulation, is probably a maximum of three to five days for most patients, according to Hogue.

Notify In Writing

Once you've determined a reasonable notice period, notify patients and their physicians verbally and in writing.

"Given the relatively short notice period, staff members should ensure that written notice is hand-delivered to patients and faxed to patients' attending physicians," advises Hogue.

Extra precaution: Be sure that your state statute or regulation does not require that you put alternative sources of care in place prior to discontinuation of services.

Keep in mind that you can defeat claims of abandonment if patients for whom services are discontinued need no further attention.

Reality check: Regulators are likely to base such a determination on whether a patient was injured as a result of termination.