Hospital Cited For Failing to Provide Follow-up Care Arrangements

The Centers for Medicare and Medicaid Services (CMS) cited West Oaks Hospital for failing to ensure that a bipolar disorder and polysubstance abuse patient was properly transferred from inpatient treatment to outpatient services for follow-up care. CMS determined that this “failed practice prevented the patient from receiving necessary aftercare and could cause a relapse in patient’s recovery.”

The patient’s treatment plan noted that the patient “required continued outpatient treatment post discharge for optimal recovery.” Despite this directive, there was no indication that the proper post-discharge arrangements were made. Although a staff member said that she faxed the patient’s medical record to the partial hospitalization program (PHP), no record of the patient could be found in the PHP log or in the outpatient clinic.There was also no documentation indicating that transportation arrangements were made for the patient.

An interview with a staff member revealed that when a CM (case manager) notifies him of a new admission to the [PHP] program, he notes the patient’s name on a piece of paper. If the patient does not show up for outpatient care for three days, he discards the paper.

The facility was required to submit a plan of correction to address its cited deficiencies and had to revise its deficient transfer/referral policies.