Calling family for TX!!!

Catsmeow · Oct 29, 2005

Just to clarify, does management want you to call all the families of all your patients, or just the family that complained? How time consuming!

In the ER I worked in, the nurses had a sheet where they would circle all the charges on, then I'd enter them into the computer. I think on the floors it was similiar, the nurses would tell the secretaries what charges to enter each day. So it was all done by the nurses, but it really didn't have anything to do with the families like you're mentioning.

rjflyn, ASN, RN · Oct 29, 2005

Well unless the patient consents its a HIPPA violation to discuss care with the family. Last I knew people in ASL's still generally run their own affairs and as such are the only ones you need to talk to unless they request their family's be consulted.

RJ

Mulan · Oct 29, 2005

What happens if you just don't call? Are they going to fire you over it?

caroladybelle, BSN, RN · Oct 29, 2005

That is completely insane!!!!!!!

HIPAA, aside.

And if the family refuses, are we to let the patient develop life threatening complications...and let them die, because of the cost?

Daytonite, BSN, RN · Oct 29, 2005

In the last LTC I worked whenever any kind of dressing supplies were needed, such as Duoderm or sterile 4X4's they were ordered from our facility pharmacy and came in a box that had a prescription label on it clearly identifying that those dressing materials belong to that particular patient. We had some families who did not use the facility pharmacy and wanted another pharmacy called to provide the supplies (Reason: cost). We also had families that wanted to be notified when treatment supplies were being ordered because of the charges appearing on their monthly bills from the pharmacy. Some families tracked those charges carefully and got on the administration if they felt the nurses were ordering too often. Some families are very savvy about charges for medical supplies. If there is something they wouldn't approve we just had to call the doctor back and get the treatment orders changed to the satisfaction of both the doctor and the family. There are many medical supplies that are not paid by Medicaid and Medicare that have to be paid by the patient (or the patient's family). Don't know if you're aware, but a box of Duoderm is VERY, VERY expensive and the family probably had a fit when they saw the charges for it. I had to get a box of Duoderm for a stasis ulcer on my leg and the cost was over $100. A problem we had to be careful of was nurses helping themselves to the treatment supplies of one patient and using them on other patients. Our facility had very few supplies in stock. I think this was done as a cost-cutting and cost-containment measure. It is perfectly acceptable for nurses in LT care to get involved in this issue of cost of supplies and discussing it with patients. It's part of a nurses role in addressing a patient's financial concerns and acting as an advocate. Most nurses have been trained within acute hospitals and because of the size of these organizations very seldom have to deal with the financial end of things. However, it is more common in nursing homes for it's charge nurses to need to be aware of a patient's financial situation.

One of our assigned projects when I was in my senior year of my BSN program was to go "shopping" at a medical supplier and get prices on a list of medical supplies our instructor had given us. It was an eye-opening experience. It is not typical for nurses to see the costs of the supplies they use. However, in LTC we are dealing with a smallar employer on one hand and the long term patient and their family on the other. It is a unique relationship.

Mulan · Oct 29, 2005

Very interesting.

I wasn't aware of that.

Bird2 · Oct 30, 2005

In Illinois the State regs state that a family member/POA/Guardian must be notified of any changes. A treatment order would be a change. Are you sure that they did not mean notification of change in condition. I would refer families to the billing department about prices and if there is a cheaper tx that would not compromise pt care I would ask the MD for a change. Is you facility all private pay?

CapeCodMermaid, RN · Oct 30, 2005

Just a few points...

1. My corporation came up with list of all the charges it might be possible for one to incur as a patient. It is at least 5 pages of small print. They told the admissions coordinator she had to review it with ALL admits even if Medicare,Medicaid,or Managed Care. Absurd! They are not paying for these things so why tell them?

2. I believe the CMS guidelines required family/HCP notification of any pressure area.

3. Duoderm on a closed area???? Not the treatment of choice. We've had really good results with Xenaderm....stage 2's especially. And it's reimbursed by both Medicare and Medicaid.

txspadequeenRN, BSN, RN · Oct 31, 2005

Now I work in a Large nursing home and we are required to call the POA for all change in orders and discuss the change of plans. If they dont want the treatment prescribed then we have no choice but to call the doctor back and have the order canceled. The majority of the time it is no problem with new orders as long as the family understands the reasoning behind it. Now having said all that garbage, if the patient is the POA discussing it with him/her should be sufficiant. Beyond that is a HIPPA violation.

Let me give you some basics about my job. I work as a floor nurse at a 150 bed assisted living facility. CNA/caregivers do all simple dressing changes and meds, the LN (we have LPN's and RN's one per shift on floor!) do all orders, MAR's, treatments, communication, diabetes care, and acute situations just to name a few of the things!
Anyway...I guess a family called our management and was upset about a charge to their bill about their family member getting tx with Duoderm and the charge billed to them. It was an MD ordered treatment for a pressure area (not open but about to).
So in their wisdom they decided that all LN's will call family memebers and let them know of the charges for all treatments and supplies! Okay we don't know what the 'charges' or 'supply costs' are...we treat patients not money! Now on top of a full run day with 150 pts, we get to spend time away from pts calling families to let them know they are being charged for that darn 'clean with NS and use a bandaid daily till resolved"!!!!!
What do you guys think? Is this as outragous as I feel it is!?!?! Did I all the sudden get a new job discription as a billing clerk/customer service rep???
Should nurses have to call family members to OKAY what a doc already ordered??? What if they say no...do I NOT do the tx? What about pt confidentialty (not all residents have their family members as their medical rep..they are able to choose on their own). And am I wrong in thinking that these items should be charged to insurance as part of pt care????
HELP!!!!!!!!!!

dinkymouse · Oct 31, 2005

Unless it is a specially ordered tx that we don't have stock supplies for the price of tx's are billed to medicare. What medicare won't pay for the corporation eats. Some of our residents are private pay and they are billed separately with the costs paid by them. We have nothing to do with this and our billing dept. takes care of all the financial things. We do have to call on any type of order including applying a bandaid, prn orders for asap and other things the families always wonder why we bother them with.

Antikigirl, ASN, RN · Nov 1, 2005

Thank you all so very much! It is great to see all the advice! Helps me to see things from other sides...which is exactly what I needed!

Okay, here is the deal as I know it...still in the works. We already call family when there is a change in condition...this includes any incident report...which we do on ALL skin issues and pain (including any ecchymosis that turn up...yep, IR's on even 1/2 cm!)...no on top of all those calls (which we don't have much time for being just ONE nurse per shift and no one else to handle these types of calls) we will have to call the family for any charges...even for Normal saline for wound cleaning, or when we change from a gauze dressing to a bandaid. I even have to inform family if we are using q-tips to clean a wound (because of the charge).

The management of our facility came up with this, and considering we monitor all skin issues with a fine toothed comb and change tx many times to cater to individual need...we will be making a TON of calls!

Sadly we can not use any products family brings. Our facility will not allow any non-pharm labled products with instruction on use..not even for nurses. So even if family wanted to bring in a box of bandaids..they would not be allowed to be used ...

The thing that gets me is when did I become insurance billing??? I don't know how much these items cost typically (I did know about duoderm...still don't understand why it has to be that darned expensive! OUCH! And yes, I did have that order changed...duo on a closed wound is wasting money for my resident when other options are so much better!

I feel that the managment should provide a billing statement with a number and person family can call if they have any billing questions...just as any other business. I am there to treat and organize treatments for my residents...not to call up families and discuss money or typically the lack there of (many of the families do not want any extras and will fight tooth and nail against patients will to have them d/C'd...that is why I don't like this! It will turn out to be a screaming match about money and directed towards the nurse...who is just doing what is best for the resident as we are dedicated to do.).

Also, just because a family is paying the bills, doesn't give them power of attourney or medical rep....found that out with my step daughter! We pay all her healthcare but are privy to NO information because she is her own medical rep (she is 16). So confidentiality dictates that even my husband, her father..can't even get med info from the facility even though we pay the bill...so I was very confused about the confidentialty there....

Thanks again guys..awesome food for thought and exactly what I needed so I can sort through all this and find out whether I will take this new task (which doesn't equate to any more money or perks...and was NEVER discussed with the nurses at all!) or leave that job!