Case Management

Q&A: Specific post-acute orders

Case Management Weekly, August 25, 2010

Q. Should physicians write an order for a specific post-acute care provider, such as an HHA or a SNF?

A. Generally, any appearance of steering patients to a specific post-acute care provider without regard for patient choice is potentially problematic. Overriding circumstances may be present when physicians specify an agency, however. For example, a patient may not want a referral to an agency and may express to the physician the desire to return home.

The physician may have counseled the patient about the need for rehabilitation and the patient may have assented as a result of that discussion. If the physician then writes an order for referral to a specific agency, it doesn’t necessarily violate a patient’s right to choose. That specific agency usually provides a service that the physician believes is critical for that patient. Discharge Planning Guide: Tools for Compliance does not address this physician-related rule. Rules govern physician referrals to entities in which  physicians have a financial interest. Discharge planners should discuss situations involving apparent self-referral with their hospital administrator after gathering objective information to substantiate the concern.

This week’s question and answer is adapted from Discharge Planning Guide: Tools for Compliance, Third Edition, published by HCPro, Inc. For more information about this book or to order your copy, visit the HCMarketplace.

Do you have a question about a case management topic? Send it to Associate Editor Ben Amirault at An answer to your question might appear in a future issue of Case Management Weekly.

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