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Based on record review and interview, it was determined the facility failed to document in their carevision case management system for 25 (Patients #1, #2, #3, #4, #5, #6, #7, #8. #9, #10, #11, #12, #13, #14, #15, #16, #17, #18, #19, #20, #21, #22, #23, #24 and #25) of 25 discharge planning records reviewed the resident or their representative was provided information of their right to choose a Home Health Agency or Skilled Nursing Facility provider.

The findings include:

On 3/22/10 at 1:30 p.m., the surveyor met with Director of Case Management (DCM), Director of Risk Management (DRM), and a Staff Risk Manager (SRM) to discuss how the facility documents patients are informed of their right to participate in their discharge planning and selection of providers following discharge from the hospital if needed.

The DCM indicated the patients are provided a list of providers by the Interdisciplinary Case Manager (ICM) and this is documented in a drop down box in carevision by the ICM. The DCM indicated that at times the attending physician may write in the name of a specific provider such as a Home Health Agency but the ICM presents the patient with a list of providers from which to select.

Interviews with 11 ICM's on 3/22/10 beginning at 2:00 p.m. and concluding at 4:00 p.m., disclosed each ICM indicating they provide the patient with a list of provider from whom to choose, they inform the patient they are free to choose any provider from a list of providers presented, and that they are not required to document why the patient did not choose the Home Health Agency owned by the Hospital. The ICM's all indicated they document this choice in carevision.

On 3/22/10, the surveyor and SRM began record review at about 4:00 p.m. The documentation of choice in carevision could not be located. The DCM was called to the area where the review was being conducted. After review of Patients #1, #2 and #3 the DCM acknowledged that documentation of the patient being provided a choice of providers was not documented as previously described.

Review of 25 patient charts on 3/22/10 and 3/23/10, did not reveal documentation in carevision of the patients involvement in the choice of a Home Health Provider or Skilled Nursing Facility for Patients #1, #2, #3, #10, #12, #15, #16, #17, #18, #19 and #24. Patients #4, #5, #6, #7, #8, #11, #13, #14, #21, #22 and #23 did not require Home Health Services as discharge planning was completed by Hospital Staff and no outside provider service was required. Patients #9 and #25 refused Home Health.

Based on record review and interview, it was determined the hospital failed to ensure that a list of Home Health Agencies (HHAs) or Skilled Nursing Facilities (SNFs) was included in the discharge plan for 11 (Patients #1, #2, #3 #10, #12, #15, #16, #17, #18, #19 and #24) of 24 patients discharged.

The findings include:

On 3/22/10 at 1:30 p.m., the surveyor met with Director of Case Management (DCM), Director of Risk Management (DRM), and a Staff Risk Manager (SRM) to discuss how the facility documents patients are informed of their right to participate in their discharge planning and selection of providers following discharge from the hospital if needed.

The DCM indicated the patients are provided a list of providers by the Interdisciplinary Case Manager (ICM) and this is documented in a drop down box in carevision by the ICM. The DCM indicated that at times the attending physician may write in the name of a specific provider such as a Home Health Agency but the ICM presents the patient with a list of providers from which to select.

Interviews with 11 ICM's on 3/22/10 beginning at 2:00 p.m. and concluding at 4:00 p.m., disclosed each ICM indicating they provide the patient with a list of provider from whom to choose, they inform the patient they are free to choose any provider from a list of providers presented, and that they are not required to document why the patient did not choose the Home Health Agency owned by the Hospital. The ICM's all indicated they document this choice in carevision.

On 3/22/10, the surveyor and SRM began record review at about 4:00 p.m. The documentation of choice in carevision could not be located. The DCM was called to the area where the review was being conducted. After review of Patients #1, #2 and #3 the DCM acknowledged that documentation of the patient being provided a choice of providers was not documented as previously described. The DCM acknowledged there was no documentation in carevision that choice of provider had been included in the discharge plan.

Review of patient records beginning on 3/22/10 at about 4:00 p.m. with the SRM and continuing on 3/23/10, revealed Patients #4, #5, #6, #7, #8, #11, #13, #14, #21, #22 and #23 had a physician's standing order for either Interdisciplinary Case Management (ICM) or Home Health. These patients were Obstetrical Patients and the discharge planning was performed by Hospital Staff and no Discharge planning for HHA's or SNF's was required.

Review of Patient #20's chart revealed discharge planning had been initiated but the patient was still in the hospital. Patients #9 and #25 refused Home Health Services.

Review of patient charts revealed Home Health Agency staff of the Sarasota Memorial Home Care was responsible for coordinating Home Health Services for Patients #1, #2, #3, #10, #12, #17 and #24. ICM staff coordinated the Home HHA or SNF discharge planning for Patients #15, #16 and #18. None of these 10 patient discharges had a list of HHA's or SNF documented in carevision as having been received in their discharge plan.

The lack of documentation was acknowledged by the DCM on 3/22/10 at about 4:00 p.m., after Patient records #1, #2 and #3 were reviewed.

Based on record review and interview, it was determined the hospital failed to document freedom to choose among participating Medicare providers for Home Health Agencies (HHAs) or Skilled Nursing Facilities (SNFs) services for 11 (Patients #1, #2, #3, #10, #12, #15, #16, #17, #18, #19 and #24) of 24 patients discharged with HHA or SNF services.

The findings include:

On 3/22/10 at 1:30 p.m., the surveyor met with Director of Case Management (DCM), Director of Risk Management (DRM), and a Staff Risk Manager (SRM) to discuss how the facility documents patients are informed of their right to participate in their discharge planning and selection of HHA or SNF providers following discharge from the hospital.

The DCM indicated the patients are provided a list of providers by the Interdisciplinary Case Manager (ICM) and this is documented in a drop down box in carevision by the ICM. The DCM indicated that at times the attending physician may write in the name of a specific provider such as a Home Health Agency but the ICM presents the patient with a list of providers from which to select.

Interviews with 11 ICM's on 3/22/10 beginning at 2:00 p.m. and concluding at 4:00 p.m., disclosed each ICM indicating they provide the patient with a list of providers from whom to choose, they inform the patient they are free to choose any provider from a list of providers presented, and that they are not required to document why the patient did not choose the Home Health Agency owned by the Hospital. The ICM's all indicated they document this choice in carevision.

On 3/22/10, the surveyor and SRM began record review at about 4:00 p.m. The documentation of choice in carevision could not be located. The DCM was called to the area where the review was being conducted. After review of Patients #1, #2 and #3 the DCM acknowledged that documentation of the patient being provided a choice of providers was not documented as previously described. The DCM acknowledged there was no documentation in carevision that choice of provider had been given and documented.

Review of patient records beginning on 3/22/10 at about 4:00 p.m. with the SRM and continuing on 3/23/10, revealed Patients #4, #5, #6, #7, #8, #11, #13, #14, #21, #22 and #23 had a physician's standing order for either Interdisciplinary Case Management (ICM) or Home Health. These patients were Obstetrical Patients and the discharge planning was performed by Hospital Staff and no Discharge planning for HHA's or SNF's was required.

Review of Patient #20's chart revealed discharge planning had been initiated but the patient was still in the hospital. Patients #9 and #25 refused Home Health Services.

Review of patient charts revealed Home Health Agency staff of the Sarasota Memorial Home Care was responsible for coordinating Home Health Services for Patients #1, #2, #3, #10, #12, #17 and #24. ICM staff coordinated the Home HHA or SNF discharge planning for Patients #15, #16 and #18. None of these 10 patient discharges had a list of HHA's or SNF documented in carevision as having been received in their discharge plan.

The lack of documentation was acknowledged by the DCM on 3/22/10 at about 4:00 p.m., after Patient records #1, #2 and #3 were reviewed.

At 4:45 p.m., the DCM, DRM, and SRM were discussing how the patient is provided the freedom of choice information. The DCM indicated that if the Physician orders home health services then Sarasota Memorial Home Care automatically receives the referral and their case managers come into the facility and provide the patient with the freedom of choice information along with a list of Home Health Care providers.

The surveyor was provided with a disclosure document from Sarasota Memorial Home Care which the patient signs. This document was not found in any of the patient records reviewed for patients receiving home care.

On 3/23/10 at 1:00 p.m., the surveyor met with the DRM, SRM, and legal counsel for the Hospital. The surveyor expressed concern that personnel from Sarasota Memorial Home Care were entering the facility and providing the freedom of choice information to patients who have a home health referral from a physician.

Legal Counsel indicated that all employees were employed by Sarasota Memorial Health System and there were not any employees per se that were hospital employees. It was explained that the Health System had employees assigned to cost centers. The Hospital is a cost center that utilizes employees of the system and Sarasota Memorial Home Care is another cost center which utilizes system employees.

The surveyor acknowledged the system may employ all employees and assign them to cost centers but that Federal regulations require the Hospital to give the freedom of choice notice and not the Home Health Agency. The surveyor indicated the expectation would be for all freedom of choice notices to come from the case managers assigned to the hospital.