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 [...]
