Referrals:
Hospital Stats Could Change Your Referral Stream
Published on Sat Jul 19, 2003
The Centers for Medicare & Medicaid Services is pushing ahead with plans to publish hospitals' home care referral statistics, and changes to referral practices could be the upshot. In a rule it calls "Nondiscrimination in Post-Hospital Referral to Home Health Agencies and Other Entities," CMS proposes to collect, maintain and publish information "about hospitals referring Medicare patients to [HHAs] with which the hospitals have a financial interest," it says in the Department of Health and Human Services Semiannual Regulatory Agenda. CMS plans to take "final action" on the rule in October, the agency notes in the May 27 Federal Register. CMS proposed the rule back in November, where it said it will most likely publish the numbers in January 2004 (see pdf of Eli's HCW, Vol. XI, No. 43, p. 347). Since CMS proposed the rule, at least one hospital has been cited for its home care referral practices (see pdf of Eli's HCW, Vol. XII, No. 16, p. 122). If a hospital's referral stats look bad enough, HHAs could see it mend its referral practice ways, predicts consultant Terri Ayer with Ayer Associates in Tuscon, AZ. For example, "where there is obvious, significant bias with referrals going almost exclusively to the hospital-based HHA," a hospital may feel pressured by freestanding HHAs in the area, CMS and/or the public to change. On the other hand, "in communities where hospitals have made the effort to fairly represent the options, the black and white numbers may end complaints" from freestanding agencies that have unrealistic expectations, Ayer offers. "Making hospitals' stats public is sure to spark a debate over what percentage of self-referrals is acceptable." Making hospitals' stats public is sure to spark a debate over what percentage of self-referrals is acceptable, expects consultant Tom Boyd with Rohnert Park, CA-based Boyd & Nicholas. "What is too much or too high?" Boyd asks. Freestanding HHAs can't fight the fact that a hospital has a natural, perfectly legal advantage in securing referrals, notes consultant Pat Sevast with American Express Tax & Business Services in Timonium, MD. Unless patients have had previous experience with an HHA or know someone in the industry, they are likely to go with whomever the hospital recommends, and the hospital is free to recommend its own agency, Sevast points out. But in those isolated cases where a hospital isn't playing fair, these publicly disseminated numbers may help wronged HHAs bring the problem to light, she acknowledges. Oversight authorities including CMS, state surveyors, the Joint Commission on Accreditation of Healthcare Organizations, the HHS Office of Inspector General and others may be much more willing to listen to an agency's complaint of patient-steering or cherry picking the most profitable patients if [...]
