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OSCEOLA REGIONAL MEDICAL CENTER 700 WEST OAK STREET KISSIMMEE, FL 34741 May 3, 2012
VIOLATION: LIST OF HOME HEALTH AGENCIES Tag No: A0823
Based on interview, record review and a review of facility documentation, the facility failed to ensure that staff did not specify or otherwise limit the selection of qualified home health care providers that were available to the patient at discharge for 1 of 10 sampled patients (#7).

Findings:

Facility policy "Discharge Planning" read, "When the patient needs home health services ... the Case Manager provides the patient or persons acting on his/her behalf with a list of Medicare certified providers who service the geographic area in which the patient resides. The patient's choice is documented on the Patient Choice form and placed in the Medical Record."

Examination of the Patient Choice form revealed the following text: "You have the right to select any provider to provide the care ordered/recommended by your physician. This is your choice."

A review of the medical record of patient #7 revealed physician orders of 2/01/12 at 1:39 PM for "Home with home health". A Case Management note of 2/01/12 at 5:38 PM read, "Also HHC (home health care) order. Spoke with pt (patient). Stated that she has not had hhc in past and therefore, is okay with cm (case manager) selecting from rotating list for HHC and DME (durable medical equipment). Agreeable to Phoenix HHC. Faxed referral to Phoenix." There was no evidence in the record indicating that the patient was presented with a list of agencies from which she could choose and make a selection. As stated above, it was the case manager who selected or specified an agency. There was no evidence of a completion of a Patient Choice form, as required in facility policy (below).

An interview was performed with the Director of Case Management on 5/03/12 at approximately 9:30 AM. She stated that patients are asked if they have a current or recent Home Health Agency with whom they would like to return. If they don't, they are provided with a list of available agencies and asked to select from one of them. Once a decision is made, they are asked to sign a form which attests to their choice. She stated that their practice is to not pick agencies for the patient. The final decision is that of the patient.

During an interview of the Quality Manager on 5/03/12 at approximately 4:15 PM, she confirmed the finding.