Can they do this??

[RN4ustat]

I work for a small rural hospital based hospice. We are trying very hard to grow our census but recently we've run into some problems. We were given a handful of referrals at the local nursing home and after our PCC evaled them and decided the patients didn't really meet criteria, they were picked up by another nearby, larger hospice. After they had been on board a few weeks, the hospice promised the nursing home they would buy them all new minis blinds and refurbish some of the rooms in return for more referrals. Is this marketing or something more sinister?

Yesterday we received a referral from a hospital discharge planner for a patient that had a cva and was coming home unresponsive. The family chose us over the larger hospice because he had heard good things about us from his co-workers who happen to have a family member on our service. The only fly in the ointment was the patients PCP, he is the medical director for the other hospice. My PCC took the orders to the doctors office for him to sign and he said "Oh no this will never do. We can't use these other hospices, they write too many orders and it will be too confusing." He called the family and then he had his office staff inform my PCC that the family had decided to go with another hospice. How can he do that?? Is this legal?? And what if anything can we do about it?? I realize that hospices are a very lucrative and competetive business right now but some of their actions seem a little unethical. Any advice would be appreciated here. Thanks!!

[doodlemom]

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.

[jsteine1]

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.

Generally speaking, thats always good advice. Seek counsel of those that know the inner workings of things. Please, however know that the tenet of Federal investigations is this: "what did you know and when did you know it?"

This means that those that had knowledge of a federal offense, were it prosecuted, could get dragged in to the situation for not coming forward. It is not unusual in cases like this that the feds will interview direct competitors of those they are investigating simply to compare responses to specific types of questions. Years ago, I was the COO of a HHA company and shortly after 2 new investors joined, the financial statements started to look mighty strange. I verbally questioned the entire accountant staff, assuming there was a software programming error and clearly demonstrating why those numbers could not possible make sense. The problem continued, I went to VP of finance, then the CEO when it became clear this was no error. He was from another industry and might not have caught this, or so I hoped. Bottom line, it was clear to me what they were doing,as the CEO did nothing about it, I resigned and went to the local Inspectors Generals office. By then, I had a paper trail of email and responses, payroll records showing changes of classification from part of the company to the other. Basically, illegal cost shifting. This was pre- PPS.

They were prosecuted heavily, paid fines of a million dollars. Those that I had communicated with early on were personally prosecuted as they knew what they were doing, that someone( me) was questioning it and they continued with it anyway. I was told a year later by the feds what the outcome was and that I would have been prosecuted right along with them had I not come foreward after many attempts to correct the situation.

I understand that business lunches and trinkets dont fall into federal offense category and are normal marketing approaches. But major capital improvements are something else again. Now, if the money for those improvements flowed out of an independently managed foundation,which may have a connection to the competing hospice ,which often occurs, and is structured correctly, thats appropriate and legal. Everyone should know that being genuinely concerned, gathering facts best you can and reporting something is the right thing to do. If you were incorrect, it all quietly goes away, no harm done.