Navigating Patient Choice and Steering Regulations

At a speaking engagement a few years back, I stated several times that hospitals that implemented a well-written transitional care brochure and accompanying consent form for the patient to sign were in fact “champions for patient choice.” 

After the presentation, someone approached me and asked, “what do you believe qualifies an organization as a champion for choice?” 

My response? Organizations which develop a brochure that lists their preferred providers (narrow network) and educates the patient of their choices are acting as champions for choice as very few hospitals have patients sign anything confirming their choice in post-acute providers. 

The consent form allows the patient to confirm in writing that they are aware they have a choice in post-acute providers. The consent form also confirms the patient was provided a complete list of providers and allows the patient to consent to those choices in writing once they have done so. 

Hospitals are using the transitional care program, as a means to better keep patients in a coordinated care model. However, regulations requiring that hospitals honor patients’ choices when selecting a post-acute provider and federal anti-steering regulations are still in place. 

These regulations completely contradict the intent of the Affordable Care Act – which is to coordinate care and get reimbursed based on value, not episode-based reimbursement (which was prevalent in the fee-for-service model). This is perhaps the biggest dilemma in coordinating care in a post-Affordable Care Act environment. 

Coordinate care without steering

Let’s start by discussing the intent of the choice and anti-steering regulations. The regulations were created to prevent and discourage unfair business practices. Whether physicians had a financial interest in an SNF, home health agency, or board and care facility, the regulations were created to ensure transparency and patient choice. 

This attempt at transparency was not limited to mischievous physicians, as post-acute providers would place relatives and spouses in jobs with high volume discharges to steer patients to their agency and ensure high volume. 

Anyone who has worked in case management, discharge planning, or the post-acute sector could likely cite several examples of conflicts of interest of this nature that they personally encountered in recent years.

The most important step any hospital or health system can take in addressing the choice and anti-steering issue when designing a transitions program is involving the compliance officer and healthcare attorneys in the process. 

This is one of the most common frustrations amongst providers at present and one of the most frequent questions I get when I am speaking at national events. The best answer I can offer is to adhere to the anti-steering regulation (as outdated and illogical as it is), by getting patient consent and acknowledgment that they are offered a complete list, a choice, of  selected the identified facilities and agencies. 

Enough already with the hospital lawyer gobblyedgook 

When you boil it all down it reduces to a very simple concept: Do the right thing by the patient. 

Our job is to communicate and share with them a plan that will keep them from being readmitted unnecessarily. And really isn’t this why we all got into healthcare in the first place? 

Imagine that the patient is your own mother. What type of communication and candidness would you want from a discharge planner? I know the answer as I was a caregiver for my mom before her passing, Bless her heart. The answer is obvious, you should do the right thing – for your mom and mine.