Cost effective patients

[SNB1014, RN]

I had AxO x4 older gentlemen for a few days in a row. The day he was to be discharged he became a bit fussy each time i had to scan his armband for meds. he said, "miss, do you have to scan me? is that so you can charge me each time for your services?"

i belted out a quick laugh, "no no, sir, this is a safety thing when giving meds, its not like a barcode at walmart"

i've also had patients out right refuse anything that they could have a family member bring in from OTC (tylenols, pepcid, colace, ASA) and refuse hospital issued pills that they take from home. for example, if they are continuing their metropolol during their stay, they refuse to take ours. we have a way of monitoring this with pharmacy when pts take their home meds, of course.

others will refuse our little skid proof socks, toothpastes, "baby wipes", etc that normally come with the "welcome to your room essentials" kit. outright say "please go back and return those from my account."

some people do this i think partially because they like their home products more, which i can't blame them. with ours, they smell hospital clean, with theirs they smell like a Hawaiian tropical coconut dream. others do it truly because of the charge,

does anyone know how much patients actually save when they do this? if we have to scan their home meds to give them (in order to account for administering them in the eMAR) and we don't scan "our" diapers, etc how much are we talking here?

I recall reading that a hospital charged a patient $1.50 for a single generic acetominophen when a box of 200 generic pills can cost $4.00 at walmart for the whole thing.

[kbrn2002, ADN, RN]

If your hospital allows pts to bring in their own supplies without still charging them for the room amenities good for them. I believe the hospital here charges for those Kleenex whether they are used or not, and at a ridiculous price! I saw a recent hospital bill for a family member where 2 Tylenol cost $5.50 I can't remember off hand what the charge was for socks and tissues, but it was way more than anyone should reasonably expect to pay. I am not sure how that works with Rx meds, I don't recall hearing of anybody bringing their own from home and frankly would be surprised if it were allowed.

[CP2013]

I tell my mom to refuse any medication we have at home. She takes pretty basic prescription meds, but just a few admissions ago, they charged as 28,000 for a kidney transplant she didn't have and $16/tablet of Synthroid (because she can't take genetic).

This last admission they charged her $8500 in respiratory treatments, which was apparently for Symbicort 3xdayx7days....she refused it after the first one made her nauseous but the nurses were charting it as done because they left the inhaler at the bedside.

If patients don't ask for an itemized bill after discharge, they would be shocked to discover what they are paying for each time!

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[calivianya, BSN, RN]

We don't charge people for socks/lotion/briefs/toothpaste/etc. so refusing lotion would be cutting off your nose to spite your face. Most people ask for "extras" to take home - to which I point out that other patients need them. I'm not giving someone five bottles of lotion because they're trying to be tightwads and not buy lotion when they get home. Stuff like meds we do charge for, though, and I don't blame people in the slightest for refusing those!

[KimO peds]

Wow this is so interesting to hear about! I'm in Canada, all this charging patients for each ind. med, treatment, surgery, KLEENEX (really?!) etc is totally unheard of! Kudos to you guys this is a whole other aspect of nursing care you have to be mindful of.

[Novo]

I'm in Canada too. I've heard that down south you guys charge patients for gloves too?!!

[cici024]

Even if you bring your own meds from home, they have to be checked by pharmacy before you can take them, the nurse holds and dispenses them, and therefore you are being charged for the service of me putting your own pill in a cup for you.

[applewhitern, BSN, RN]

We don't charge for items like toothpaste, deodorant, etc. Maybe it is already calculated into the bill for the "room." As a matter of fact, I have never worked at a hospital where we charged for tissue and toiletries, but since it isn't "free" for us, either, I am sure the patient is paying for it somehow. I did work at a hospital that received diapers, formula, baby-wipes, etc., as donations from the suppliers, and we did not charge for those.

[applewhitern, BSN, RN]

We would have to get an order from the doctor to "give their own meds."

[gonzo1, ASN, RN]

When I have chemo I was told that I should take 2 tylenol before I come in, or they would give it to me. I noticed a few months ago that even when I take my own at home they still charge me for 2 tylenols (9.95$). I am assuming it is the charge for them charting that I took my own tylenol at home. I decided to not question them since I work for that hospital system and don't want to make any enemies.

[Guest219794]

Even if you bring your own meds from home, they have to be checked by pharmacy before you can take them, the nurse holds and dispenses them, and therefore you are being charged for the service of me putting your own pill in a cup for you.

If you tell the nurse you are taking them.

I don't don't spend much time as a patient, but when I do, I pay attention to costs. I recently had an insurance policy that had me covering %30. If I was in the hospital, and had my own PRN's, I would take them and not tell the nurse to save the money.

[dirtyhippiegirl, BSN, RN]

I don't think that they can literally bill for every box of kleenex or bandaid used because there's simply no way of charting such. I'm sure that it gets factored into the what...$2,000/day med-surg room costs? Same with most nursing cares. Like how you rent a hotel room -- the costs of the furniture, linens, and the housekeeping isn't per individual cost but it's all tied into the base room cost.

I imagine that items that can be legitimately tracked -- medications, UHS supplies (which gets scanned once a day at my hospital) like pumps and wound vacs, consults (although I'm curious as to whether non-doc consults like PT/OT, case management, and dietary bill separately like a doc would?), procedures are directly billed.

I work in burn and we bill per dressing change but it's based on percentage size, not actual dressing supplies used. The actual dressings can run very expensive which is why you see a lot of burn centers closing down.