Hard to place patients

I am a Nurse Evaluator working in the acute care hospitals.

We often get referrals for those really hard to place patients. Heavy care, crappy insurance, MRSA, VRE etc that require a private room.

I have a case right now that is really challenging. We've had the patient at our facility before and the administrator just doesn't want him back. He has Med A but hasn't applied for T-19. Our reimbursement rate for Med A wouldn't begin to cover what his daily cost would be.

The CM is really coming down on me hard about it. Requesting I screen, rescreen and screen again. Trying to pin me down to commit to taking him. I'm really trying to be diplomatic about it but in the best interest of patient care, don't want her to stop looking for other placement.

We are not required by law to hold his bed and we have not. Plenty of other facilities have denied him, why are WE getting hounded so much? My hands are tied, my administrator will not allow me to accept him.

We used to be a "dumping ground" for all the difficult placements, when our census was in the toilet and we needed "heads in the bed" to keep corporate happy. We are now at a place where we can pick and chose the patients we take. There are facilities that won't even look at a patient with T-19, but we do. I've got to keep a healthy case mix though, in order for us to stay solvent.

I understand the pressure CMs are under to move patients off their units, but at what point does no mean no? I don't want to have to take a hard line in order to maintain good working relations with her, but she just won't let it go. Any recommendations on how best to handle the situation? We are all in this together.