Referrals:
HHAS HAVE NEW WEAPONS AGAINST PATIENT-STEERING HOSPITALS
Published on Thu Jun 10, 2004
New OIG compliance guidance, Medicare COPs head off shady referrals. If hospitals fail to give patients discharged to home care a list of home health agencies, they'll risk incurring the wrath of the HHS Office of Inspector General and their surveyors. In new draft supplemental compliance guidance to hospitals, the OIG spells out that hospitals must "as part of the discharge planning process:
(i) share with each beneficiary a list of Medicare-certified home health agencies that serve the beneficiary's geographic area and that request to be listed and
(ii) identify any home health agency in which the hospital has a disclosable financial interest or that has a financial interest in the hospital."
When finalized, the draft guidance "will supplement the OIG's prior compliance program guidance for hospitals issued in 1998," the OIG explains in a June 8 Federal Register notice. The OIG will take comments on the guidance through July 23. It is "significant that the OIG chose to include language in the supplemental guidance that mirrors the language of the Balanced Budget Act of 1997," remarks Burtonsville, MD-based health care attorney Elizabeth Hogue. Any doubts about hospitals'legal obligation to present a list of HHAs "has now certainly been put to rest," Hogue says. The OIG's emphasis on the requirement should motivate hospitals to get in line with the law, if they haven't already, expects attorney Mark Langdon with Arent Fox in Washington, DC.
"The government clearly has another tool to use to help ensure patients'right to freedom of choice of providers," Hogue cheers. COPs Detail Hospitals'HHADuties Another potential tool to help HHAs fight hospital patient steering is the Centers for Medicare & Medicaid Services' proposed changes to the hospital conditions of participation. The BBA provision was intended "to address concerns that some hospitals were referring patients only to HHAs in which they had a financial interest, and that shared financial relationships were influencing referrals to other entities," CMS says in a May 18 Federal Register notice containing a host of changes for hospitals, including changes to the discharge planning COPs. "Hospitals essentially have a captive patient population and, through the discharge planning process, can influence a patient's choice regarding who provides posthospitalization services," CMS warns. Under the proposed COPs, hospitals would be required to:
give a list of Medicare-participating HHAs that request to be listed to patients discharged to home care;
document in the patient's medical record that the list was given to the patient;
update the list annually and ensure its legibility;
inform patients that they have a choice of post-acute providers; and
disclose financial interest in HHAs on the list. Hospitals could simply print up a list of HHAs from Medicare's Home [...]
