Can they do this??

Regarding the competing Hospice offering to pay for capital improvements to the nursing home: That's absolutely against Medicare Law. Its called inducement to refer. When Medicare is the primary payor source, the HHA or Hospice cannot provide any inducement to get referrals, not even baseball tickets! If you are relatively sure about this, you should report it. This type of action on the part of your competitor , if it can be proven, could result in loss of their provider number, fines or prosecution of those involved. You would not have to be the one to prove it, but you should report it to the office of the inspector general and let them investigate.

I have several thoughts on this, having dealt with it for many years. All medicare certified agencies, HHA or Hospice, have to establish an advisory board. Getting a potential referral source to serve on this board is always a smart thing, but not a guarantee of referrals. Getting one of the biggest referring docs on that board is even smarter, but also not a guarantee he or she will refer to you. However, These advisors are not paid a lot of money, some arent paid at all. If I were the Nursing Director of your Hospice, I would look into a couple of things before jumping to conclusions about the doctor:

1. Why not ask the same doctor to sit on YOUR advisory board or serve as YOUR medical director. I know many docs who participate in 2 or 3 agencies.

2. Look into your procedures for obtaining orders. Could they be streamlined or made to be more Doctor-friendly?

3. Has the director or community relations nurse at your agency called on this doctor and his office staff to find out why he doesnt have confidence in your agency? What are this doctors hospital affilitations? Ask around, has he had any political or other difficulties with his patients at your hospital in the past? The hospitals administration would know this.

4. Docs who refer to HHA and hospice, over time, get particular about who they refer to due to their interests in protecting their medical licenses. They want to know that the nurse reporting an issue or asking for a med change from the patients home is skilled in assessment, so that he can order changes with confidence.

Physicians can not order patients into or out of hospice, much less into or out of a particular hospice. The physician's only role in that regard is to make a hospice-appropriate diagnosis. If I understand your situation correctly, the PCP had already made the '6-months-or-less diagnosis.' He therefore cannot rescind his diagnosis until the patient/family elects the hospice of his choice. Unless of course he is willing to risk losing his license and doing a little jail time. That, it would seem to me, would be taking a very large risk for a very small return. However, having worked most of my life in small communities, I am abundantly familiar with the 'big-fish-in-a-small-pond' mentality... which has a tendency to breed almost unbelievable levels of arrogance in certain individuals. But once State & Federal authorities get involved, these individuals quickly discover their 'pond' is much larger than they ever imagined, and that it contains 'fish' a great deal larger than themselves.

And another thing...

Just to clarify a point: a physician can not order a patient into or out of hospice, but can only make a hospice-appropriate diagnosis. What the physician thinks of any particular hospice is irrelevant. It is the choice of the pt/fam to decide if or which hospice they want. Physicians might advise which hospice they think is best, but even that is getting into slippery territory. To have his office call you and speak for the pt/fam is clearly overstepping his authority. Whether from sheer ignorance or, as previously suggested, an unbelievable degree of arrogance, this PCP has put a noose around his own neck and handed you the end of the rope. You now have to make the choice of whether or not to hang him.

This happened just yesterday and with respect to a family member of mine.

I arranged for hospice services for a relative who will be discharged from the hosp in a few days. The admitting surgeon signed off and was in full agreement. The family GP ( different doc)was making rounds and arbitrarily changed the hospice I selected to the one with which he is affiliated. The Social worker and the hospice group we selected both called me to tip me off that this happened. The chat between myself and that GP was not pretty and of course, our wishes will prevail. I will also be sending a certified letter of complaint to the medical board here.

That GP just lost two patients: the hospitalized patient and his wife.

Regarding the competing Hospice offering to pay for capital improvements to the nursing home: That's absolutely against Medicare Law. Its called inducement to refer. When Medicare is the primary payor source, the HHA or Hospice cannot provide any inducement to get referrals, not even baseball tickets! If you are relatively sure about this, you should report it. This type of action on the part of your competitor , if it can be proven, could result in loss of their provider number, fines or prosecution of those involved. You would not have to be the one to prove it, but you should report it to the office of the inspector general and let them investigate.

Are you sure? Because I thought , as long as it was not a personal gift to anyone, it could be given, provided it can be used AT the facility, such as mini blinds and such...

I would almost bet my life on this. Refurbishing any part of the facility is a gift to the ownership of the facility to which some degree of gratitude(ie, referrals) would be expected or implied.

I won't comment on the mini blind affair because I do not know the law on that account, but one other factor does come to mind.

Small town 'politics' are often very, shall we say, 'complex.' Your hospice is clearly sitting in the driver's seat as far as the law is concerned; the PCP in question is clearly way out of bounds... ethically and legally. But however correct you may be, you must think in the long term. You could clobber the guy now, but how will that affect the other physician's in your community in the future?

You are 'in the right'... but sometimes you have to ask yourself, "Would I rather be right... or happy?" Having spent most of my life in small, rural communities, I would suggest you listen to the most politically savvy person in your agency before deciding on a course of action. A quiet discussion in some 'back room' may settle the whole thing to everyone's satisfaction.

I don't think it is illegal for a doctor to refuse to work with a certain hospice, just like a nursing home can decide whether or not they want to work with a certain hospice. I would imagine that the MD, just like a nursing home, is allowed to say to the family...I am sorry but I/we do not work with that particular hospice. If I were a doctor and I had had a bad experience with a particular hospice, I would not want my patients using them. Of course, this could be a whole different issue. BTW, I've seen many hospice's and home health agencies, drug companies, etc... giving out ball tickets, theatre tickets, taking administrators out to lunch, etc...I don't think that's illegal either unless they actually state "we will give you this if you give us this." I think that most for profit hospices are too business saavy to make that mistake. This is pretty standard practice in marketing. If the hospice that you are speaking of actually said we will give you the blinds if you give us patients, then I would imagine that would be illegal. Our hospice decorated and donated all of the equipment for a room in a nursing home that was dedicated "the hospice room." We are the only hospice that that facility uses and they are planning some more rooms.

Another issue...sorry to go on...The hospice that I am working for has started going with the idea that if a doctor states their pt is dying then even if you are doubtful, admit them. You then watch them through the first certification period and if they are not appropriate, then they are discharged. Many times, someone who did not appear to be appropriate a few weeks ago now does. I have had a hard time accepting this philosophy because I was an admissions nurse for several years and I would always use the LMRP's to assess someone's appropriateness. While I would look for another diagnosis in order to get someone admitted, there were always those who were blatantly not appropriate. The medical director and the executive director both state that this is perfectly legal - and it has really boosted our census. The people that we discharge generally come back in a few months because they know what services they will get from us. While I question the ethics of it, if we don't do it then all of the for-profits will gobble up all of the patients.