High Cost Medications - page 3

Do you all have a cap on spending for medications? We screen everyone coming in and usually say no to anyone on high cost Lovenox or high cost Zyvox....a 14 day course is about $4000. What SNF can... Read More

  1. by   mlbluvr
    "Knock, knock". "Who's there?". "SNF". "SNF WHO?". "SNF Village. We're here to 'prescreen' your last Medicare referral to us. The LAST one left after only 2 days, but cost us $23,000, and had already used up all her MED-A days. THREE WEEKS AGO!".
  2. by   mlbluvr
    [QUOTE=MunoRN;7448053]At one time, lovenox was very expensive, although since going generic, enoxaparin costs about $400 for a 14 day supply if you're buying it at walgreens, much less if you're buying for a facility of patients." I'll argue for the sake of it, that Walgreens or Wal-Mart or AARP online or etc. would be a better price for sure, if the SNF wasn't obligated to be at the mercy of its contracted institutional pharmacy. This post makes it appear as though the SNF has the ability to shop around for prices, or even possibly 'buy Lovenox in bulk'? Hmm.
  3. by   CapeCodMermaid
    Perhaps it's geographic, but of the last 20 referrals we got, 14 of them were on Zyvox. Or Zyvox AND IV Cefapime AND IV Diflucan. These people are very ill, and can't participate much with therapy. Or the only thing they need is IV antibiotics. I've been in the business for years and have worked in many different places. Not once were we ever told that we could bill separately for Lovenox. It's called bundled billing for a reason.
  4. by   CapeCodMermaid
    Quote from MunoRN
    I don't doubt that SNF's lie and say they don't have an available bed for a patient, even though they do, they just don't think they'll profit as much off this patient as they would like, but it's still illegal to do so. If you want medicare patients, you have to take them all, that's the law.
    I do not have to take every person referred to me. If I cannot provide the care they require or their actions could put my other residents at risk, I do NOT have to accept them.
    I don't know where you get your information.
  5. by   MunoRN
    Quote from CapeCodMermaid
    Perhaps it's geographic, but of the last 20 referrals we got, 14 of them were on Zyvox. Or Zyvox AND IV Cefapime AND IV Diflucan. These people are very ill, and can't participate much with therapy. Or the only thing they need is IV antibiotics. I've been in the business for years and have worked in many different places. Not once were we ever told that we could bill separately for Lovenox. It's called bundled billing for a reason.
    If the national average for zyvox use is .002% of the population, and the Physicians in your area are prescribing it to 70% of patients in SNF's, then that's a problem between the SNF's and your inept Physicians.
  6. by   MunoRN
    Quote from CapeCodMermaid
    I do not have to take every person referred to me. If I cannot provide the care they require or their actions could put my other residents at risk, I do NOT have to accept them.
    I don't know where you get your information.
    I got my information from CMS. If a patient requires a level of care you cannot provide then you can refuse them, if you cannot provide the level of security necessary then you can refuse them. If you think you might not make money on them and you take other CMS patients, then you cannot refuse them, that is illegal, and worse, unethical.
  7. by   MunoRN
    [QUOTE=mlbluvr;7448608]
    Quote from MunoRN
    At one time, lovenox was very expensive, although since going generic, enoxaparin costs about $400 for a 14 day supply if you're buying it at walgreens, much less if you're buying for a facility of patients." I'll argue for the sake of it, that Walgreens or Wal-Mart or AARP online or etc. would be a better price for sure, if the SNF wasn't obligated to be at the mercy of its contracted institutional pharmacy. This post makes it appear as though the SNF has the ability to shop around for prices, or even possibly 'buy Lovenox in bulk'? Hmm.
    Nobody buys lovenox in bulk, facilities buy medications in general in bulk, if any facility is paying more than what you'd pay at Walgreens, then somebody failed in their job.
  8. by   MunoRN
    Quote from mlbluvr
    "...while it has forced SNFs to be more careful in their screening processes." This is exactly the point the OP made. And since this quote is over 13 years old, it's only that more relevant today.
    I think that was the point, despite laws preventing SNF's from bilking the system, they continue to steal from the system through creative screening techniques.
  9. by   mlbluvr
    As I sit here shaking my head as in "Come AGAIN?", I just recalled a quote from W.C. Fields: "If you can't dazzle them with brilliance, baffle them with bull."
  10. by   MunoRN
    Maybe you could be more specific?
  11. by   mlbluvr
    Quote from CapeCodMermaid
    Do you all have a cap on spending for medications? We screen everyone coming in and usually say no to anyone on high cost Lovenox or high cost Zyvox....a 14 day course is about $4000. What SNF can afford that cost for one resident for 2 weeks of meds?
    My experience, the average was $45/day, up to maybe $60 (with corporate- level OK) with IV meds (if the IV supplies are obtained through central supply, versus the pharmacy), based on projected RUG (with rehab being involved heavily) after the 5 day. And yes- OTC meds were included in the total. Claritin, Prevacid, and the other 500 OTC meds the SNF pays for- $15 a day or so, easy.
  12. by   morte
    You left off the last word.....
    Quote from mlbluvr
    As I sit here shaking my head as in "Come AGAIN?", I just recalled a quote from W.C. Fields: "If you can't dazzle them with brilliance, baffle them with bull."
  13. by   mlbluvr
    Begins with "C", 4 letters? SHIRT?? Forgot to insert that if the patient was already living LTR in the SNF, and she was wanted back (because she's a 'peach'), then she wouldn't be costed out even if her MED-A stay would probably be a $ loser. After all, a LTC 'peach' is good to find, too!

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