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CAPC Palliative Care Discussion Forum
Designing a Program
palliative care referral to homehealth. Author: jbrant
Date: Feb 8, 2012 2:11 pm
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1. If asked by the HHC/H agency to see them, with the approval of the attending MD there is no issue
2. If an attending MD asked him to see a homebound patient and he feels they need/would benefit from HHC he should make that recommendation to the referring (attending) MD and let she/he work out which HHC agency to use with the patient
3. There is a small group of patients who have not been seen in the attending's office for years and the attending ultimately requests a home PC consult. Because the patient remains homebound the PC consultant agrees to serve as the attending on a go forward basis. In this case, where the PC consultant is a contract only employee of the HHC/H agency, one has to clearly document that choice was provided to the patient/family if HH or hospice is needed. The likelihood of any issues arising in such rare circumstances would be extremely low. If, however, it turned into a regular occurrence the PC consultant and the HHC/H agency may be at risk for violating self-referral laws.
David Weissman, MD
CAPC Consultant
1.) The most important laws that cover physician behavior are those that control the practice of medicine. In all states, their medical practice acts say something about the duty to treat patients, and not to abandon them. Therefore, under that rubric, you are ethically and legally bound to take care of patients who ask you to take care of them.
2.) Secondarily, the Stark regulations say that you may not unduly enrich yourself or a company that you own in the care of patients by setting up 'self-dealing' referral patterns. In this case, as a contract employee, as long as your contract does not give you a 'bonus' for every patient you refer, or your remuneration or benefits are not affected by your referral behavior, you are in good shape.
3.) Thirdly in importance, under the Social Security Laws that ensure choice for Medicare beneficiaries, they must have a choice of any 'willing and able' agency to care for them. As long as you can demonstrate you provide choice, you are 'safe'. Because there is a medical advantage to having them with your agency, you are free to say that--it falls within the practice of medicine, not the business of healthcare. I am presuming that you would be happy to be their PCP even if they were with another agency, it would just be more challenging, and less comprehensive.
We see a lot of 'abandoned' patients in southern California. For our hospice agency, more than 50% of our 1000 hospice patients now have our doctors listed as PCP. It's a real burden--be careful what you wish for!
Charles F. von Gunten, MD, PhD
Provost, Institute for Palliative Medicine at San Diego Hospice
Clinical Professor of Medicine, UCSD
cvongunten@sdhospice.org