Don’t just ensure patient choice; document it

The right paperwork is essential

Given the current controversy over discharging patients to hospital-owned home health agencies and the expected growth of managed care, the issue of providing patients with a choice of health care services is likely to remain a source of concern for case managers and federal regulators, experts say.

At the Children’s Hospital of Pittsburgh, case managers have taken steps to ensure that patients are appropriately advised of their right to choose a home health provider different from the one the hospital partially owns. They’ve taken a particular interest since conducting a mock survey with the Joint Commission on Accreditation of Healthcare Organizations, based in Oakbrook Terrace, IL.

"They were real interested in what we do about offering choice," says Janice Zimmer, RN, manager of care coordination at the hospital.

Anne Kobs, associate director for standards at the Joint Commission, confirms that JCAHO has become particularly interested in the issue. "Basically, ethically, what we’re saying is that the organization needs to tell the patient, ‘We have a home health agency affiliated with our hospital,’" she says. "‘However, here are some other agencies in town or near where you live, and you can feel free to choose any one of them.’"

Kobs adds that such choice should be offered to the patient even if the patient’s insurance will cover only one home health agency in the area. "The patient basically needs to be aware that there are choices," she says. "The most cost-effective choice for them might be that particular hospital’s own agency. But the decision has to be theirs."

To ensure that patients understand the options available to them, Zimmer and her colleagues provide a letter to the patient’s family. The letter explains that Children’s Hospital of Pittsburgh has a preferred provider agreement with one home health agency, then goes on to list "five or six" others, Zimmer says.

"And we have the family sign that they have been given a choice," Zimmer adds. "That’s really what we do in order to document that we’ve provided choice and given that option. We really try very hard to make sure that we’re doing that, even with those whose coverage is exclusively with one company. If we find that we haven’t done that, we’ve slipped, or we’ve missed one, then we’re just that much more careful to do it [the next time]. It helps to cover our bases."

[For more information on discharge planning standards and regulations, contact:

Anne Kobs, associate director for standards, Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Blvd., Oakbrook Terrace, IL 60181. Telephone: (630) 792-5902.

Or Janice Zimmer, RN, manager of care coordination at the Children’s Hospital of Pittsburgh, 3705 Fifth Ave., Pittsburgh, PA 15213. Telephone: (412) 692-6021.]