Tuesday, April 5, 2011

Patients' Right to Choose Providers

By Elizabeth E. Hogue, Esq.

The right of patients to choose providers who will render care to them is currently based upon three key sources:
 
  • Court decisions that establish the right of all patients, regardless of payor source and the setting in which services are rendered, to control treatment, including who provides it.
  • Federal statutes for both the Medicare and Medicaid Programs that establish the right of patients whose care is paid for by these programs to choose providers who render care in the absence of a waiver.
  • The Balanced Budget Act of 1997 (BBA), which currently requires hospitals only to provide a list of home health agencies to patients.  According to the BBA, the list must meet the following criteria:
    1. Agencies that provide services in the geographic area in which patients reside, are Medicare-certified, and request to be included must appear on the list given to patients.
    2.  If hospitals have a financial interest in any agency that appears on the list, this interest must be disclosed on the list.
    * Conditions of Participation (COP’s) of the Medicare Program that are the same as the provisions of the BBA described above.

Despite the existence of these requirements that are intended to protect the right of patients to choose providers, there is a lingering perception, however unfair it may be, that hospitals give “lip service” to patients’ right to freedom of choice, but still operate based upon a culture that emphasizes ownership of patients and the need, and perhaps even the right, to go to great lengths to keep patients “within the system.”  Case managers/discharge planners are likely to see more enforcement actions by state survey agencies with regard to the rights of patients to choose their providers.

Action taken by a provider in Indiana is instructive.  Specifically, the provider documented instances of alleged violations and reported them to the state survey agency.  Surveyors treated the reports like a complaint and conducted a complaint survey of the hospital's practices.  Surveyors concluded that the hospital violated its own policies and procedures and the provisions of the Balanced Budget Act in the process of making referrals for home health services.  The hospital received a statement of deficiencies and was required to submit and follow a plan of correction (POC).

This action opens the door for clear enforcement action against hospitals and other providers who violate patients' right to freedom of choice.  If violations are at the condition level of deficiencies, providers could, at least in theory, lose their right to participate in the Medicare/Medicaid Programs.

The right of patients to choose providers has generated considerable conflict within the provider community.  This right is likely to be tested and reinforced.  Case managers/discharge planners need a thorough understanding of the issues in order to stay out of the fray.
 
(To obtain more information about the fraud issues discussed above in a book entitled Medicare/Medicaid Fraud and Abuse: A Practical Guide for Providers, send a check to Elizabeth Hogue for $30.00 including shipping and handling to: Fulfillment, 107 Guilford,Summerville, SC  29483.) 

©2011
Elizabeth E. Hogue, Esq.  All rights reserved.
No portion of this material may be reproduced in any form without the advance written permission of the author.

20 comments:

  1. I think choosing right hospital is one of the most important decision you'll have to make because good hospital can provide you good medical facilitates.
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    Replies
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  2. I agree with you there, If it is true that Medical Directors cannot complete face-to-face encounters and documentation of them, the new requirements are more likely to be problematic to implement. I think they will so stress with it. Amina Hospital Ajman

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  6. My father was diagnosed with amyotrophic lateral sclerosis (ALS) in the summer of 2013; His initial symptoms were quite noticeable. He first experienced weakness in his right arm and his speech and swallowing abilities were profoundly affected. We all did our best to seek help for this disease no medications they prescribe worked ,we were all scared we might lost him due to his condition, as he had been his brother's caregiver a few years earlier for the same disease before he past. doctor recommend nuatural treatment from total cure herbal foundation for his ALS we have no choice to give a try on natural organic treatment ,this herbal cure has effectively reverse my father condition ,losing his balance which led to stumbling and falling stop after the completing the herbal supplement which include his weakness in his right arm and his speech, natural herbs from totalcureherbsfoundation .co m home remedy is the best although their service is a little bit expensive but it worth it, they save lives.

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  12. Hello Everyone out there,I am here to give my testimony about a Herbalist doctor who helped me . I was infected with HERPES VIRUS in 2012, i went to many hospitals for cure but there was no solution, so I was thinking how can I get a solution out so that my body can be okay. One day I was in the river side thinking where I can go to get solution. so a lady walked to me telling me why am I so sad and i open up all to her telling her my problem, she told me that she can help me out, she introduce me to a doctor who uses herbal medication to cure HERPES VIRUS and gave me his email, so i mail him. He told me all the things I need to do and also give me instructions to take, which I followed properly. Before I knew what is happening after two weeks the HERPES VIRUS that was in my body got vanished . so if you are also heart broken and also need a help, you can also email him at {dradigba@gmail.com} or whatsapp him number: +2348077875210.Contact him today and you will have a testimony…Good luck!... DOCTOR ADIGBA CAN AS WELL CURE THE FOLLOWING DISEASE:-1. HIV/AIDS2. HERPES3. CANCER4. ALS5. Hepatitis6 Diabetes7 LOVE SPELL8 IF YOU NEED YOUR EX LOVER BACK TO LOVE YOU AGAIN.     

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  14. ColoFlush is effective in cleansing the colon to get rid of the root causes of ill health, and not only suppressing uncomfortable symptom. what can a diabetic eat at bojangles

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  15. Thanks for sharing the information. I agree that every one should have a right to choose provider and I think every one is utilizing his right. There are always some standard to choose provider. similarly, for skin treatment, patient should note some points first before going to the clinic.
    Therefore, I suggest getting to the aesthetic clinic in Lahore and getting checked by a dermatologist. They will scan your face and guide you through the reason and treatment. Acne treatment in Lahore is the best option to get rid of acne with premium and fast results.

    ReplyDelete
  16. Its very important to make sure the quality and ingredients of the product before adding it to your skin routine. Markets and store are full of such harmful products that will ruin your skin and causes acne, redness of skin and rashes on skin.
    But the question is how to check the quality?
    Step1: Check the ingredients of the products and consult with dermatologist either to use the product or not?
    Step 2: Trust the brand and take consultation directly from brand.
    As I trust on LARC and I buy the products with fully satisfaction. As I also face an issue of acne and without any doubt, I use best face wash for acne in Pakistan by LARC. It will help to control the melanin and make your skin glowing.

    ReplyDelete
  17. The author's passion for lifelong learning is inspiring. It's evident in the depth and breadth of their content, which constantly evolves and adapts.

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