Recently my hospice company decided to stop covering antibiotics for these infections. I am just livid as I feel they are for comfort. We don't pay for OTC including tylenol, dulcolax, cough meds. For 10 years at each hospice I have worked for (just 3) we have always covered them. of course, if they are on our formulary, I still call them in at our expense. I will wait until I'm called in to stop doing it.
We also used to get each admission a comfort pack to include dulcolax, tylenol, ativan, roxanol, phenergan and ABH. Now only pt's with a cancer diagnosis get these upon admission. and it takes an act of congress to even get ABH. we cannot get any compound meds, gels, and they don't want us to get liquid either.
What is wrong with these people....... I can always make it come back to the hospice diagnosis, so I just don't understand how they cannot see it.
Are any other companies doing this?
Oct 21, '12
Yes, Lifepath Hospice.org in Florida does. Yes I agree, treating the bladder cramps, and probable urinary retention related to a UTI, and treating the pain, SOB, and anxiety associated with dyspnea related to pneumonia, are considered compassionate comfort measures. Infection is a complication of immobility. I strongly suggest writing to your state legislature. Is your company for profit? Lifepath is not.
Oct 21, '12
Never mind the state legislature ... they have no authority over hospice operations.
Write to CMS ... the medicare/medicaid oversight body. Their website:Home | Centers for Medicare & Medicaid Services
One place to start might be the
ombudsman: 1-800-633-4227. If your company has clients in LTC, your own state ombudsman might also be helpful.
Finally, if your company is a chain that operates multiple sites, there might be an ethics hotline. It wouldn't be the first time a local site administrator pulled something shady to make his/her numbers look good to corporate. Use a phone other than one that can be traced to you, personally.
Nov 9, '12
Funny . .. I tested a patient's urine today. Positive for Leuks and blood. Got an order for Septra DS and delivered it.
We have a Symptom Relief Kit but we don't automatically take it out on all patients. Only if they have a need for it (uncontrolled pain, nausea, wet respirations, etc.). But we use it for the patients regardless of diagnosis. Don't patients with CHF have pain? Don't patients with ALS have pain?
Nov 10, '12
Thanks for the input; much appreciated!
Nov 12, '12
My hospice covers ABT ONLY if it relates to the primary hospice diagnosis. So yes for URI for someone with COPD, NO for UTI on almost everyone. We provide Roxanol, tylenol and phenergan suppositories, Ativan, and atropine drops as a "comfort kit" for all patients. Cough meds are only covered for pulmonary disease patients and everyone is provided with tylenol and dulculax (and similar meds such as MOM, Miralax, Magcitrate, etc) the reasoning being that almost without exception a hospice pt will run a fever as part of the dying process and the comfort meds often cause constipation. Recently however, they have stopped paying for duragesics on all patients, saying this is "not formulary". I have been with hospice for 7 years and this was unimaginable even 1 year ago. Medicare has made a lot of cutbacks over the years from what I understand and the companies are adjusting.
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