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Patient Freedom of Choice

Patient Freedom of Choice

Patients have complete “freedom to choose” where they receive follow-up services once discharged a hospital. In fact, hospitals are legally required to “inform the patient or the patient’s family of their freedom to choose among participating Medicare providers of post hospital care services and must, when possible, respect patient and family preferences when they are expressed. The hospital must not specify or otherwise limit the qualified providers that are available to the patient.”

Unfortunately, many hospitals and discharge planners/case managers interpret this to mean that they cannot support or assist the patient with their decision or provide any information that would influence it. This is a common misconception and simply not true. In fact, physicians, case managers and other hospital personnel are not only some of the best resources that a patient can utilize when searching for the next setting of care, but the hospital is actually required by law to provide the patient with information on skilled nursing facilities and home health care providers available to patients as part of the discharge planning process.

Specifically, the law states that:

  • “The hospital must include in the discharge plan a list of home health care agencies (HHAs) or skilled nursing facilities (SNFs) that are available to the patient, that are participating in the Medicare program, and that serve the geographic area (as defined by the HHA) in which the patient resides, or in the case of a SNF, in the geographic area requested by the patient. HHAs must request to be listed by the hospital as available.
  • This list must only be presented to patients for whom home health care or post-hospital extended care services are indicated and appropriate as determined by the discharge planning evaluation.
  • For patients enrolled in managed care organizations, the hospital must indicate the availability of home health and post hospital extended care services through individuals and entities that have a contract with the managed care organizations.
  • The hospital must document in the patient’s medical record that the list was presented to the patient or to the individual acting on the patient’s behalf.
  • The discharge plan must identify any HHA or SNF to which the patient is referred in which the hospital has a disclosable financial interest.”

In short and simple terms, hospitals can be compliant with patient choice laws if they:

  1. Inform patients they have freedom to choose
  2. Present a neutral list of post-acute care providers to patients with any necessary financial and ownership disclosures
  3. Support patients in making their choice without any steering or resistance.
  4. Help patients make a choice when the patient (or family / caregiver) cannot choose or seeks input and assistance.

Discharge planners, case managers, and even nurses can and should be a reliable source of unbiased information during discharge planning. They should be aware of existing resources and feel empowered to use them. For example, public reports and quality metrics are unbiased tools that they can use to help patients differentiate among post-acute care providers while supporting patient autonomy. Hospital employees should be encouraged to share this data and information with patients and their families.

Transitioning to a new setting of care is stressful for any patient, and having to choose follow-up care with limited information can add to that stress. Patients and their families often look to doctors, nurses and other hospital employees for support in these times. It’s clearly in the best interest of the hospital to make the care transition as seamless as possible for the patient. Providing all patients discharged to post-acute care with basic, unbiased information is a simple and legally compliant first step to improve that process and can go a long way in improving patient satisfaction and outcomes. To learn more about hospital discharge planning, read our blog post.

repisodic makes patient choice easy.  Learn more about our free resources and tools to help patients find the right follow-up care every time:

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