Posted on Saturday, March 16, 2019 8:10 PM
The Office of the Inspector General (IOG) of the Department of Health and Human Services recently issued an advisory opinion stating the federal rule against offering patients free care does not prohibit a hospital from providing free home care if the goal is to reduce readmissions. The OIG advisory opinion was a response to a guidance request from a non-profit medical center that offers free home care to patients with congestive heart failure.
The federal government prohibits the provision of free services to patients for the purpose of influencing their care decisions (anti-kickback rules) and they also penalize hospitals for high readmission rates. Providing free home care to patients may potentially violate anti-kickback rules that forbid using programs to drive future business from patients, but, in this case, the OIG ruled the benefits “outweigh any risk of inappropriate patient steering that the (law) was designed to prevent,” in its advisory opinion.
“While this application of discretion may indicate a generally favorable attitude toward programs that – like the proposed program – contribute to better patient outcomes and coordination of care, such a discretionary approach may make it difficult for providers to reliably predict the risk associated with programs they are considering,” wrote health care attorney Erica Krauss of Sheppard Mullin Richter & Hampton LLP., in the National Law Review. “The OIG’s narrow interpretation of the “promotes access to care” exception – dismissing its application to the entire program based on one program element’s inability to promote access to care with no analysis of the impact on such barriers of other program elements – contributes to this difficulty.
NAHC has some concerns about this advisory opinion. “The advisory opinion raises a concern for us that is distinct from the areas analyzed by the OIG, says NAHC President William A. Dombi. “Specifically, the scope of services within the paramedics activities encompass services that can and are provided by home health agencies under Medicare and Medicaid home health benefits. That raises the question as to whether the patients involved have received the required services of discharge planning by the inpatient hospital prior to being directed to the paramedic services. It is possible, that by using paramedic services rather than home health services for post-discharge in-home follow-up, the health system has disadvantaged the patient who may then lose the more extended services that are available under the home health benefit, including nursing, therapy, medical social work, and home health aide services.
“The actual project may exclude homebound patients, but the advisory opinion is not clear on that front,” continued Mr. Dombi. “Instead, it indicates that the services provided by the paramedics is not covered when provided by paramedics under a federal health care program. However, those services may be covered under home health benefits.”
Source: NAHC Report
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