Federal regulators have thrown weight behind ensuring that patients have a more active role in their care transitions. The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) recently drafted compliance guidance for hospitals on the topic.
Under the guidance, OIG requires hospitals to share a list of Medicare-certified home health providers that serve a patient’s geographic area. The goal is to make sure patients’ freedom to select a home health provider is being honored.
In general, OIG’s guidance falls in line with the Centers for Medicare & Medicaid Services (CMS)’s 2019 updates to the discharge planning requirements for home health providers.
“I think [OIG’s guidance] is very consistent with this,” private-practice attorney Elizabeth E. Hogue told Home Health Care News. “CMS has said there’s information that patients and their families have to get immediately when they request it, related to discharge planning and care. I think that’s exactly what OIG would like to see — as much information as possible given to patients and their would-be caregivers, so they can make good decisions.”
Specifically, CMS’s rule required hospitals to give patients and their families access to information that would help them make informed decisions about their home health provider options. This information includes data on quality measures and resource use measures.
At the time, CMS’s rules around discharge planning put to rest an industry-wide call for more clarity.
Aside from building on CMS’s 2019 rule, OIG’s guidance also addresses fraud head-on.
Hospitals are required to identify any home health providers they have a financial interest in — and vice versa. This helps prevent hospital discharge planners from pushing patients toward a specific provider that they may favor or have business relationships with.
“I can only really speak anecdotally,” Hogue said. “What I hear is when hospitals have an ownership interest in a home health provider, discharge planners and case managers may come under a lot of fire and feel pressure to refer most, if not all patients, to those entities.”
Hogue noted that OIG was concerned with hospitals accepting kickbacks from home health providers in exchange for referrals.
“The OIG has sort of been targeting discharge planners and case managers recently,” she said. “I’ve talked about the things post-acute providers have given them that cause them to refer to providers. [This included] … Louis Vuitton pocketbooks, trips to Napa Valley. In other words, kickbacks in exchange for referrals.”
Still, OIG’s oversight is a win for home health providers. It ensures that providers that fall outside of a referring hospital’s financial interest and aren’t offering kickbacks have a fair chance to care for patients being discharged.
“The preference, if not mandatory referrals, to entities owned by the hospitals has been a perennial problem for providers who are not associated with a hospital,” Hogue said. “[Providers] complain about it and have for years, quite bitterly saying, ‘All we want is a level playing field. We will compete along with everybody else, but we can’t when hospitals own these entities and put pressure on their discharge planners.’”