Admitting patients for the sake of admitting?

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I am curious about this. I just discharged a patient who was on service for 9 months. She left the area and moved back to our service area. I just saw her last week or so. Yes, it;s the same patient I am wishing would just go away lol.

None the less, she is so NOT appropriate for hospice its' not funny. She is a dx CHF. Thin, no edema. walks around her house with no o2 and biggest issues is a regular bowel movement. LOL no kidding.

None the less, I got the call from the patient asking if I could come by and "readmit her". Just to show you how much the family listened to me, I advised them to call our office and get admissions to assist them whenever they were ready to return. They got my cell phone number due to me not blocking it and hence the call I told them not to make.

I called our admissions dept and made the referral. I told them about this case, about how she maybe not found appropriate per Medicare Guidlelines. I was told, well, because Dr. N referred her, we HAVE to admit her!

OMG... this is not the first time Ihave heard my agency say this. Is this clearly medicare fraud?? I have seen patients admitted just o appease the doctor and not really have any declining need. THis also might explain why my soon to be old agency is being ADRd by Medicare?

Feedback?? :nurse:

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Specializes in Hospice.

This is Medicare fraud. This practice will hopefully be going away with new Medicare guidelines- they are really trying to crackdown on this stuff. Pt being admitted/recerted in 3rd benefit has to be seen by MD PRIOR to admit/recert starting Jan 1. This is my understanding anyhow. Good luck! My agency seems to only get pt's that die within hours to days!

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I am really annoyed that this agency I have chosen to work with has been doing this very routinely lately. Taking patients according to the doctors. Dare not admit them if they aren 't appropriate as it will offend a referral source. I am done with this bunch... I feel like being a whistle blower.. but we already have 30% of our charts pulled for ADRS. GO MEDICARE go get em.

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

yup...walk away professionally and find an employer whose values reflect your own.

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I can honestly say I am positive my agency is commiting fraud. We are in the middle of a ADRs... and I am thinking there is more going on here than I can see.

I know for sure there have been patients that only a few weeks ago I tried to dc only to be shot down by my manager. I was actually told to be quiet or quit by a superior, so yes, I am leaving on this and few other issues.

My big question. Do I call Medicare? Or will it just fall as is it is? :nurse:

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I've been a hospice nurse for nine years.....I've found it to be maybe 30% legit and the rest is gaming the system for profit. Even with the new regs I don't see things changing.....just more paperwork and creative writing.

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I am looking at filing a complaint still. Today I am to admit a person with a form of Luekemia, who is asking for everthing to be done including transfusions, cpr etc. My agency is insisting we admit.

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

Transfusions are not an uncommon part of the palliative plan of care. Acceptance of DNR status often takes time, education, support, and trust. Some never accept it and that is not a deal breaker for hospice in most places.

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Transfusions are not an uncommon part of the palliative plan of care. Acceptance of DNR status often takes time, education, support, and trust. Some never accept it and that is not a deal breaker for hospice in most places.

exactly.

and it sounds like some of these hospice agencies, are indeed utilizing pall care...in which there is a distinction, and medicare will reimburse for life-prolonging procedures.

and as tewdles stated, transfusions are definitely a palliative measure.

i'm not seeing anything unusual about this hospice pt.

dying is a journey.

lots of people don't quite understand that concept,.

leslie

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I've been a hospice nurse for nine years.....I've found it to be maybe 30% legit and the rest is gaming the system for profit. Even with the new regs I don't see things changing.....just more paperwork and creative writing.

Elderly people decline and pass away. I do not see how that makes hospice care necessary. One on one when you live in an ALF? There are many who are not so privileged that decline and pass away in LTC facilities. Why can't they also get one on one care?

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Elderly people decline and pass away. I do not see how that makes hospice care necessary. One on one when you live in an ALF? There are many who are not so privileged that decline and pass away in LTC facilities. Why can't they also get one on one care?

NO insult meant. But one on one care at an Assisted Living Facility? I have never seen that before in my 8 years of nursing. where do you live?? ... often there is lack of staff, and frankly the amount of board and care here in California could easily be used in a SNF or even 24 hour private caregiver.(about 5-6K and you dont' have acccess to a licensed nurse.. not a bargan ) More often then not, these ALF"s are staffed by unskilled individuals with the name of MED TECH who was given a course on medication administration. They are often clueless on how to do PRN"s effectly, what is really an emergency. ( FYI I just got an after hours call from one of these ALF's who was hysterical because one of our dementia patients is actively dying and can no longer swallow... yet, they wanted to feed her!! OK... this is the battles of ALF'S that I personally deal with... Sorry, I do NOT agree with your opinion, but then again, I see the results of ALF's with end of life care on a daily. basis.. usually ran and staffed with people who are clueless about patient transition, symptom management and EVERYTHING is an Emergency.. FYI.. this call I just got the administrator told me she was going to pray for my soul as I sound like the devil.. ha ha )

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I am looking at filing a complaint still. Today I am to admit a person with a form of Luekemia, who is asking for everthing to be done including transfusions, cpr etc. My agency is insisting we admit.

I forgot to add she ( the patient ) plans on accessing chemo and does not want to be a dnr.. the plot thickens.. ha

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