Home Health & Hospice Week

Use the new requirement as a tool to make sure hospital referrals are on the up-and-up. 

Ensuring hospitals give patients a choice of home health agencies just got easier, thanks to a finalized hospital condition of participation on discharge planning.

The basics: Starting Oct. 1, a revised hospital COP specifically requires hospitals to give a list of Medicare-participating HHAs to patients discharged to home care, document giving the list, keep the list current, inform patients that they have a choice of post-acute providers and disclose any financial interest the hospital might have in HHAs on the list (see Eli's HCW, Vol. XIII, No. 21, p. 164).

Hospitals' failure to perform these tasks "brings them out of compliance with the conditions of participation," which puts their Medicare participation at risk, notes attorney Mark Langdon with Arent Fox in Washington, DC.

The requirement aims "to make sure that beneficiaries can make informed choices about what providers to use," Langdon notes. And it strives "to prevent inappropriate steering of patients to HHAs affiliated with hospitals."

Bob Wardwell with the Visiting Nurse Associations of America hopes "this rule will reduce genuine referral abuses that involve deceptive practices and misinformation, things that no hospital should be tolerating itself in the first place as a simple matter of ethics."

While HHAs are happy to see the Centers for Medicare & Medicaid Services making efforts to keep hospitals accountable to the Balanced Budget Act of 1997 listing requirement, they may not be thrilled with how CMS has gone about it. In the final rule on the inpatient hospital prospective payment system, which contains the revised COP, CMS gives hospitals quite a bit of latitude in how to put together and maintain the list.

For example, in the proposed rule CMS floated a requirement to update the list once a year. "We have decided to be less prescriptive and not require the hospital to update the list annually," CMS says in the final rule. Instead, CMS will expect hospitals to keep their HHA lists "current. This provides hospitals the flexibility to determine how often it is necessary to update their lists."

Burtonsville, MD-based health care attorney Elizabeth Hogue worries this flexibility will lead to widespread non-compliance. "The more specific regulators are about protecting patient choice, the better for all concerned," Hogue tells Eli. "The flexible approach doesn't seem to be working because we regularly encounter clear-cut violations of patients' legal and ethical right to freedom of choice."

It's probably easier for everyone, especially hospitals themselves, if CMS would just stake out some clear rules on the list, adds clinical consultant Pat Sevast with American Express Tax & Business Services in Timonium, MD.

"CMS could have been more prescriptive on the hospital listing process, in view of some [...]