Cost effective patients

[SNB1014]

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.

[merlee]

Never a good idea to 'not tell' the nurse that you are taking you own meds - what if it interacts with something, or makes you sleepy? I am surprised you would do this.

Why do they charge so much for a Tylenol, or similar product? The order was transcribed, double-checked, filled/delivered by pharmacy, finally, brought in by the nurse and charted. And if it is a prn, hopefully the nurse used her judgement as to the need for the med, and eventually charted whether or not the med was effective. Isn't that worth the cost?

And all those incidentals are not necessarily charged to the patient, but they are tracked as inventory. What if most of a product, like those socks, are constantly disappearing from a particular unit? Where are they going if not to the patients?

Something like lotion or deodorant could be used by anyone at their own home.

It is important to check your itemized bills and to call about inappropriate charges. Whether it is for meds or treatments you did not receive, or some test you cannot recall having, it is important that your bill is correct.

Cost-effective? How about each of us just making sure that we only use what we need, and no more. If patients bring their own meds there needs to be a dr's order for approval, and the meds need to be charted as such.

Will they start bring their own gowns and sheets? Oy.

[Meriwhen, ASN, BSN, MSN, RN]

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

Same here, but only for medications which we do not carry in our pharmacy and would have to special-order, or for medications that we just don't issue period (e.g., methadone isn't given at one of my jobs. Patients can bring in their own and we'll continue them on it, but we neither stock nor prescribe it).

Even then, we take custody of the meds (e.g., they don't stay with the patient's belongings but are locked up in the med room and issued from there) and the "use own meds" order is only good until the pharmacy gets the medication in.

[carolinapooh, BSN, RN]

I decided to not question them since I work for that hospital system and don't want to make any enemies.

If someone in billing is discussing your financial business with someone else, that's a breach of privacy and possibly a HIPAA violation. I personally wouldn't be willing to give money BACK to my employer that they didn't deserve.

Some charges are included in the standing orders for each procedure, and when the case is processed in billing, everything gets charged. I'd dispute it. I've worked in onc clinics; the nursing 'charges' are included in the fee you pay just to walk in the door and receive your treatment. (Like an office visit charge.) They're charging you ten bucks for two Tylenol that you're not taking because it's a standard order; it's got nothing to do with charting charges because nursing costs are covered by the office visit and are not itemized.

[imintrouble, BSN, RN]

When I was a student, long ago, I had a 40-something man who had no insurance and wouldn't take the Morphine he had ordered for pain. He'd fractured an arm when a car fell off the jack while changing a tire....for someone else.

He wouldn't take anything. No toiletries, no PO meds, no IV flds. Nothing.

You could see the anxiety on his face, "How am I going to pay for this".

[umcRN, BSN, RN]

No idea if they save much but I did get an itemized bill for my hospital stay. Those little mouth care kits in the ICU? $30, TED socks? $50...can't remember all the details right now but I remember being pretty shocked

[umcRN, BSN, RN]

Will they start bring their own gowns and sheets? Oy.

I brought my own pillow and blankets. Much nicer than the once provided and made me more comfortable. Also the second I was able to get the gown off and into my own PJ's I did...nothing related to cost at all. I work in peds and plenty of parents bring in their own blankets, sheets and even hospital gowns for the kiddos just to make it more like home

[NurseDirtyBird]

Several years ago, before I got into nursing, my mom was in a serious accident. We got her itemized bill after she was released, and saw they'd charged TEN FREAKING DOLLARS for EACH 4x4 used in her daily dsg changes. I don't know if that was the jacked up price they charge the insurance company (she had a good plan at the time), or if it's what they charge everyone. I work for the same system that cared for her now, and make sure I use only what I need, no extras. I don't want my patients to have to deal with that nonsense.

There are a few incidentals that aren't charged for (as far as I know - I don't have to scan them in) like tape and alcohol swabs, but darn near everything else is scanned. Shampoo, insulin syringes, IV flushes, Kleenex, orange juice. It's pretty ridiculous.

[kalevra, BSN, RN]

There are some patients that understand the value of healthcare provided to them. There are also other patients who do not understand the value of the healthcare they are provided.

It is my experience that patients that do not take the healthcare services that they have been provided for granted , are the same patients who treat staff with the utmost respect.

I love these patients. They are always so courteous and respectful.

[Laught3r]

A hospital i worked in used a sticker system. Every box of tissue, bottle of lotion etc had a sticker that had to be put on a form that had patient name on it. for bandaids there was an area at the botom of the page that could be tallyed. Dresing supplies abviously had sstickers. it was crazy. I would walk out a room with stickers all over my shirt.

[Twinmom06, ASN, APN]

the hospital I currently work in doesn't charge individually for items, they are figured into the room charge - we have an open supply room (well badge controlled) and we go in and get what we need...

the hospital I did clinical in had ALL supplies (including tape and individual bandaids) in a pyxis like cabinet called an Omnicell and you had to charge out every.single.item - down to combs and toothbrushes...

things like gloves and tape were charged out to the floor though

[vintage_RN, BSN, RN]

Wow. I'm in Canada and i cant believe in the US they charge for every little thing, drugs, charging per dressing change?!?! I can't even fathom that. The only thing we pay for for a hospital stay is maybe the ambulance ride there. I had a wound dressing changed once and the nurse stuffed a huge bag full of way too many extras than I would ever need. We may have our drawbacks (wait times, higher taxes) but im very thankful to live here!

[PediLove2147, BSN, RN]

I had a patient ask if she could take her own meds to save money, we apparently have a policy that they are only allowed to do this if we didn't stock a particular med. Pharmacy needs to verify and bar code home meds with a doctors order as well.

We don't charge (we do obviously but not individually) for things like toothpaste and tissues. Patients are charged for pills as they are taken out of the pyxis, that is why I always return if they don't take them. I hate when I see meds hanging around which means someone is paying for a med they didn't even take.

I received an itemized bill after my hospital stay and I was shocked, I would prefer to stay in the dark.