Beth Kastner and Shannon DeBra on Patient Steering and Charting [Podcast]

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By Adam Turteltaub

It’s critical for patients leaving the hospital for a post acute care (PAC) provider that the handoff be conducted well. Some facilities will be better suited to the patients needs than others, which is why the process needs to be handled properly, with discharge planners making recommendations based on patient need, rather than the financial interests of the hospital or PAC.

Unfortunately, explains Beth Kastner, Member, and Shannon DeBra, Senior Counsel, at Epstein Becker & Green, that’s not always the case. Patient steering and charting can take place, with bad outcomes for everyone involved.

While there is no official definition of patient steering, it has been informally defined as the practice of directing patients and/or their caregivers to PAC providers that do not align with the patient’s goals of care and treatment plan. It can also be defined as inappropriately influencing the patient and/or care giver.

Traditionally this occurs when the hospital, or its discharge planner, has been remunerated in some way by the PAC. As recent cases have shown, that could come in the form of gift cards, massages or even a free cruise. It might also be delivered as staffing for the hospital paid for by the PAC.

Whatever the form, it’s improper and could lead to a very large settlement and termination of the Medicare provider agreement.

Patient charting is a scheme in which a PAC is given access to patient data to identify patients for referral to their facility. It’s a practice that holds multiple risks, including anti-kickback and privacy.

So how can a hospital stay ahead of this risk? First, train the staff that remuneration comes in many forms and carries substantial risks. Second, reinforce that discharge planning must be done in the best interest of the patient. Third, watch carefully, including ensuring that all arrangements are in writing and reviewed by legal or compliance before signing.

Listen in to learn more about the issue and the do’s and don’ts of preventing patient steering and charting.