Q&A: Physician orders for postacute care

Q. Should physicians write an order for a specific postacute care provider, such as a home health agency or skilled nursing facility?

A. Generally, any appearance of steering patients to a specific postacute care provider without regard for the patient’s 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. This book does not address this physician-related rule. Rules govern physician referrals to entities in which they 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.

For more information, see Discharge Planning Guide: Tools for Compliance, Fourth Edition.

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