Patient choice and HME

Sunday, September 26, 2010

YARMOUTH, Maine - When it comes to getting referrals from hospitals, the odds may be stacked against independent HME providers.

Hospitals are required by law to present a list of home health agencies and skilled nursing facilities to patients and offer them choice. But they're not required to do that for HME companies, say industry attorneys.

"Hospitals don't have to give the same degree of detail for HME that they have to give for home health," said Neil Caesar, president of the Health Law Center in Greenville, S.C.

It's a different story, though, if a patient requests to use a certain HME company.

"If that's the case, the hospital has to give it to them," said Elizabeth Hogue, a private practice attorney based in Burtonville, Md.

Unfortunately, there's little that independent HME companies can do about the first scenario. There may be, however, something they can do about the second.

"They can gather statements from patients saying their rights were violated--that the patients told the hospital they wanted company X and they didn't get it," Hogue said. "Then they can go to the hospital--forget case managers and discharge planners; go straight to the CEO--and say, 'Look, you're violating patients' rights.'"

If the hospital doesn't straighten up, independent HME companies can then go to their state's survey agency and request that it conduct a complaint survey, Hogue says.

Healthcare reform may change the rules of this game a bit. The Department of Health and Human Services may have the discretion to apply to HME a provision that requires physicians who make referrals for certain imaging services to present a list of providers and offer choice.

"HME is the toughest nut to crack, because it doesn't have (the protections) that everyone else has," Hogue said.