Home Health & Hospice Week

When hospitals are barring your access to patients and their records, what can you do? A lot, legal experts say.
 
Having that access ensures better discharge planning for home care patients who had to go into the hospital. It also helps agencies protect against partial episode payment (PEP) adjustments when patients transfer to another HHA, in the middle of the episode, after a hospital stay (see Eli's HCW, Vol. XIII, No. 12,p. 90).
 
Experts advise taking these steps when hospitals won't allow you to visit your patients:
 
Start with education. Chances are the hospital may be keeping you out purely due to "ignorance," suggests William Dombi with the National Association for Home Care & Hospice. That's especially true when the reason it cites is the Health Insurance Portability and Accountability Act (HIPAA).
 
Burtonsville, MD-based attorney Elizabeth Hogue says some state home care associations have engaged her to give presentations on HIPAA discharge rules and have invited hospital discharge planners and physicians in addition to home health staff. "They come in droves," Hogue says of the discharge planners.
"They are dying for the information."
 
Writing letters and making visits to hospital managers to point out relevant laws and regulations often will do the trick, Dombi says.
 
If hospitals aren't allowing any agencies in to see patients, taking a "risk management" approach to explaining why they should is smart, Hogue counsels.
 
"Show them why it's in their best interest," advises attorney Deborah Randall with Arent Fox in Washington, DC. If they see the discharge planning perks (smoother transition) and financial benefits (earlier discharges and fewer readmissions) to themselves, they're more likely to come around.
 
Next step: report them to the authorities. For pretty much any reason the hospital is keeping you out, you have a good reason to report them to state surveyors, the Joint Commission on Accreditation of Healthcare Organizations and even the HHS Office for Civil Rights.
 
State surveyors are your quickest route to resolution of the problem, Dombi believes. Whether you report offending hospitals for HIPAA violations, violation of patient choice and the Balanced Budget Act of 1997 or lack of appropriate discharge planning, surveyors will be the quickest to respond to the allegations.
 
If it's a HIPAA violation or misuse, the OCR can get involved, although its timeline is likely to be longer than surveyors', Dombi predicts.
 
Just be sure to have the hard evidence to back up your allegations, Dombi warns. That can include a written hospital policy (if there is one), specific instances documented by your staff, contemporaneous logging of conversations with hospital officials and their outcomes, and corroboration including incidents tracked by multiple HHAs or multiple incidents tracked by one HHA.
 
If you fail to back up your allegations with specific documentation, surveyors are likely [...]