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Home Health & Hospice Week

Referrals:

4 Steps To Improve Your Hospital Referrals

Published on Thu Sep 09, 2004

Reach out to hospital execs before you call on the authorities.

It's a common complaint - patients go into the hospital and come out discharged to other home health agencies. But you shouldn't take the problem lying down.
 
Nursing Care Inc. in Wood Dale, IL, is having just such a problem with a local hospital that is significantly impacting the agency's referrals, administrator Vera Krot tells Eli.
 
"This hospital is not complying with patient choice rules," Krot complains. The agency needs a way to inform hospitals of their patient choice responsibilities and make sure the hospitals know they will be held accountable to the rules, she says.
 
The Balanced Budget Act of 1997 requires hospitals to give patients discharged to home care a list of area home health agencies, notes Mary St. Pierre with the National Association for Home Care & Hospice. "Hospital responsibilities haven't changed" since the requirement went into effect in 1997, St. Pierre points out. But a newly finalized hospital condition of participation on the requirement, set to take effect Oct. 1, may help hospitals focus in on this responsibility, she notes.
 
The COP, finalized in the Aug. 11 Federal Register (see Eli's HCW, Vol. XIII, No. 29, p. 226), requires hospitals to:
 

  • maintain a list of qualified HHAs;

     
  • furnish the list as part of the discharge plan to patients being discharged to home care;
     
  • document in the patient's medical record that the hospital presented the list to the patient/family;
     
  • inform the patient/family "of their freedom to choose among participating Medicare providers" and "respect patient and family preferences when they are expressed;"
     
  • "not specify or otherwise limit the qualified providers that are available to the patient;" and
     
  • disclose any financial interest the hospital has in an agency to which a patient is referred.
     
    The rub has been getting hospitals to comply with the requirements in a climate of little enforcement. Agencies hope the new discharge planning COP will help remedy the situation.
     
    But referral problems won't just go away on their own, St. Pierre warns. "Agencies need to be more proactive" in addressing referral problems that come to their attention, she urges.
     
    St. Pierre and Burtonsville, MD-based health care attorney Elizabeth Hogue offer these tips on how to do so:

     1. Get on the list. You can't complain about not being on the hospital's HHA list if you've never requested to be on it, as required by the BBA. Use this sample letter provided by Hogue to ensure your inclusion on the list and gently remind hospitals of their responsibilities under the new COP (see box, next page).

     2. Document problems. If you continue to encounter problems with receiving your rightful referrals, it's time to record the specific instances, Hogue advises. "Document violations of patients' right to freedom of choice by hospital personnel in statements signed by patients," she recommends.

     3. Communicate with the hospital. You can catch more flies with honey than vinegar, and running straight to the authorities with problems you have with the hospital could land you in the middle of a blood feud. Try the diplomatic approach first.
     
    Set up a meeting with the appropriate hospital administrators to air your concerns, explain your problems and cite specific instances of violations, St. Pierre counsels. "You want to avoid bad feelings" if possible while still emphasizing that the hospital has to comply with the law, she suggests.
     
    A more hard-line approach may be to write the hospital CEO a letter describing specific problems and including the supporting statements signed by patients, Hogue recommends. Using legal counsel to take the statements and send the letter is the most effective way to get hospitals' attention on the matter - and results, Hogue claims.

     4. Talk to surveyors. If the diplomatic approach fails to yield the results you desire, you may have to play hard ball. Take your complaint to the state, St. Pierre instructs. You can also contact Centers for Medicare & Medicaid Services central and regional offices and accrediting bodies such as the Joint Commission on Accreditation for Healthcare Organizations, Hogue adds. Again, be specific in your complaint or surveyors may dismiss it as sour grapes. 
     
    Editor's Note: The finalized hospital COP is at     www.access.gpo.gov/su_docs/fedreg/a040811c.html.

     

    "Dear [Hospital Executive]:

    The Balanced Budget Act of 1997 and Medicare's Hospital Conditions of Participation require hospitals to develop and maintain a list of home health agencies that meet the following criteria:

    (1) Are certified by the Medicare Program.

    (2) Provide services in geographic areas in which patients served by the Hospital reside; and

    (3) Ask to be placed on the list.

    The law and the COP, published in the August 11, 2004 Federal Register, require hospitals to distribute the list of home health agencies to patients being discharged to home care. They also prohibit hospitals from "limiting or steering patients to any specific HHA or qualified provider."

    Since our agency meets all of the applicable criteria listed above, we are writing to ask you to add the name of our agency,__________________________, to the Hospital's list.

    We would appreciate receipt of a copy of the list that includes the name of our agency.

    Thank you for your assistance with this matter.

    [Your Agency]"
    Provided courtesy of health care attorney Elizabeth Hogue.

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