Home Health & Hospice Week

Recent survey deficiencies against an Indiana hospital may give freestanding home health agencies just the leverage they need to win referrals from hospitals.

Indiana State Department of Health surveyors recently cited Rochester, IN-based Woodlawn Hospital for its non-compliant home care referral practices (see Survey & Certification this issue). The development "definitely strengthens the hand of providers who complain about referral practices of hospitals," says Burtonsville, MD-based health care attorney Elizabeth Hogue.

Provider-based HHAs are quick to point out that the majority of hospitals play fair with home care referrals and adhere to ethical and responsible policies and procedures. But freestanding agencies long have argued that some hospital-based HHAs use their unique status to steer patients onto their rolls, and the dispute at times has gotten vicious.

For agencies living with hospitals that don't play by the rules, there seems to have been no options as regulators and fraud-fighters turned a deaf ear to complaints about referral practices, Hogue notes. Freestanding HHAs felt forced to suffer with no recourse under patient steering, cherry-picking (hospital-based agencies accepting only the most profitable patients), and other questionable arrangements.

Providers suffering under such practices now appear to have a place to turn - state survey agencies, cheers Hogue, who has furnished legal counsel to Professional Home Care Inc., the agency that sparked the complaint survey of Woodlawn. "Until now, it was unclear who would take responsibility for enforcement," Hogue says.

The Balanced Budget Act of 1997 included a provision requiring hospitals to hand out a list of Medicare-certified HHAs in the area to patients discharged to home care. Last November, the Centers for Medicare & Medicaid Services finally proposed incorporating the requirement into regulation and publicly sharing hospitals' referral data in the hopes of combating patient steering to a hospital's own HHA (see Eli's HCW, Vol. XI, No. 43, p. 347).

When that provision is finalized, surveyors will be even more interested in citing illegal home care referral practices, predicts attorney Elizabeth Pearson with Covington, KY-based Pearson & Bernard. But HHAs might not have to wait for that finalization. "I'm surprised Indiana picked up on this already," Pearson notes. "It absolutely will help" providers facing hospital referral problems.

Under survey rules, providers aren't subject to fines or other drastic measures, but they must undergo a survey and submit and adhere to a plan of correction, Pearson notes. "It doesn't have teeth, but just the scrutiny of a survey" might be enough of a threat to scare wayward hospitals into compliance with the law, she forecasts.