Clinical programs at Vanderbilt University Medical Center routinely provide various forms of patient assistance: one department will give out low-vision aids, another will sponsor all the slots at an overnight camp for pediatric burn survivors, another will give patients preoperative nutritional supplements that help promote recovery after surgery.
Some VUMC patient assistance programs apply to patients and families across the board, while others are need-based. But all these programs are intended to comply with one or more exceptions to federal laws that prohibit providers who serve federal health care programs from inducing patients, especially Medicare and Medicaid patients, to seek care with a specific hospital, health system or provider.
Patient assistance, it turns out, can pose stiff criminal and civil penalties for individuals and health care facilities.
Behind federal laws such as the Civil Monetary Penalties Law and the Anti-Kickback Statute are concerns that inducements for patients or referring providers could bias health care decisions and, left unchecked, even lead to rampant overuse of health care services that are federally reimbursed.
The Patient Assistance Committee is reminding employees that, in the interest of compliance, patient assistance — offers of goods or services for free or at less than market value — are subject to centralized review and monitoring at VUMC. All patient assistance, regardless of the source of funding, must be registered here (employee login required). For more information, consult the Evaluation, Approval and Oversight of Patient Assistance Programs policy. (A number of related policies can be found on VUMC’s policy site using the search term “patient assistance.”)
“We first of all would like to recognize and thank departments for seeing each patient they serve as a whole person and, in seeking to improve patient outcomes, offering assistance beyond what would strictly be considered medical care,” said Dawn Crumel, JD, managing counsel, Office of Legal Affairs. “We want to support this activity and to enable innovative patient assistance at VUMC while managing regulatory risk.”
Crumel mentions a few of the legal exceptions under which patient assistance is intended to operate. Assistance valued at $15 or less is apt to be OK, provided it never adds up to more than $75 for any one patient in any 12-month period. Items given to promote access to care might be OK, as might items given to aid preventive care. Often, the exceptions are conditioned on the assistance not having been advertised. Also ruled out: cash giveaways and cash equivalents such as gift cards or gas cards.
Presidents of all six VUMC hospitals are among the members of the Patient Assistance Committee, co-chaired by longtime faculty leader Patty Wright, MD, incoming chief medical officer for adult ambulatory clinics, and Clisby Hall, JD, senior advisor on health policy in Clinical Enterprise Administration.
VUMC patient assistance is distinct from financial assistance, which is overseen by the Financial Assistance Committee.