Cut Throat Competition Makes Me Sick

[westieluv]

I had been out of hospice nursing for a couple of years until recently, and maybe I had just forgotten or it has gotten worse, but I'm finding it very sickening to watch hospice companies circle around potential clients like buzzards, coaxing people onto hospice who may or may not really be appropriate by "tweaking" eligibility, and literally and figuratively running to grab a poor, ill patient before another hospice swoops in and grabs them.

The company that I work for (but not for long, I'm thinking, because I think this is unethical) will nag the patients and families in our home health care census who they think might remotely be hospice appropriate to sign on to hospice to beef up our census when most of the time the patient's PCP is not at all on board and does not agree that the patient is hospice appropriate. The company will simply find another physician to go along with it, even if the patient is then admitted by two physicians who are both affiliated with our company. How is this legal, much less ethical?

The current "death for dollars" culture in hospice companies makes me sick.

[QuiltDog]

I agree 100%. It is the unethical and greedy hospices that make us all look bad. The times have definitely changed.

[westieluv]

I have seen marketers and management personnel in my company dig into a patient's medical record and if they don't have most of the obvious indicators in eligibility, they will twist words and "invent" ways for them to be eligible. They openly discuss "going around" the patient's PCP if they do not agree with admitting the patient to hospice. When I worked in hospice before, I understood that two physicians, the patient's PCP and the hospice medical director, have to agree to signing the patient on to hospice. If we use two physicians that are affiliated with the hospice company to circumvent the PCP, is that even legal? Isn't that a conflict of interest?

Our marketing people are running around in circles trying to meet quotas and being chastised and disciplined if they do not achieve the right numbers. People...we are talking about people DYING here! How heartless must we be when we start hunting down people to die just to make the company's quota and fill the financial pot????

I don't even want to be a part of this company anymore, because I think that they are unethical and probably outside of the law in how they do things.

Absolutely unbelievable! The corporate culture in today's healthcare is cold and heartless, both to healthcare staff and to patients.

[lifelearningrn, BSN, RN]

Disgusting! IMO, hospice should NOT be about the bottom line. Shouldn't *some* things be sacred? Good Lord these companies make me sick.

[xoemmylouox, ASN, RN]

Everyone wants to be profitable. This means be low down and dirty sometimes. This is sometimes the result of capitalism. It isn't always pretty. Don't think it's just Hospice though. It's many healthcare industries. It's just upsetting to us because we focus on the patients not the $$.

[nurseblob]

I once cared for a ltc resident who stayed on hospice for five years. There was little change in her health during that time. When I asked the hospice nurse how the resident could still qualify for hospice, she said "well, she could go at any minute." I assumed as much since the lady was in her late eighties. They did finally discharge her from hospice. The resident died about three years after that.

[westieluv]

A lot of hospice nurses are under great pressure to find a way to recert a patient, even if they don't meet criteria. So, somehow they find SOMETHING that qualifies them, even if they have to streeeeeeeeeetch the truth just a bit. The non-profit hospice that I used to work for would discharge patients from hospice if they no longer met criteria. I never realized how straight up and honest they were, as compared to so many out there.

[CapeCodMermaid, RN]

I can't condone low life practices like trolling for patients, but everyone needs to make money to survive. You like your paychecks so somehow the Hospice company has to make money.

I have contracts in my SNF with 4 different hospices. They are NOT all the same but they all have to re-certify the patients. The rules are strict and I don't know any hospice that wants to be accused of Medicare fraud. Unfortunately, we have people who get better on hospice, probably because of the extra attention they receive and consequently, they are not eligible any longer.

[Guttercat, ASN, RN]

I have seen marketers and management personnel in my company dig into a patient's medical record and if they don't have most of the obvious indicators in eligibility, they will twist words and "invent" ways for them to be eligible. They openly discuss "going around" the patient's PCP if they do not agree with admitting the patient to hospice. When I worked in hospice before, I understood that two physicians, the patient's PCP and the hospice medical director, have to agree to signing the patient on to hospice. If we use two physicians that are affiliated with the hospice company to circumvent the PCP, is that even legal? Isn't that a conflict of interest?

Our marketing people are running around in circles trying to meet quotas and being chastised and disciplined if they do not achieve the right numbers. People...we are talking about people DYING here! How heartless must we be when we start hunting down people to die just to make the company's quota and fill the financial pot????

I don't even want to be a part of this company anymore, because I think that they are unethical and probably outside of the law in how they do things.

Absolutely unbelievable! The corporate culture in today's healthcare is cold and heartless, both to healthcare staff and to patients.

Corporate culture really has put a wet blanket on health care in many places.

You could always go back to acutes. :)

(ducks under desk)

[lifelearningrn, BSN, RN]

I can't condone low life practices like trolling for patients, but everyone needs to make money to survive. You like your paychecks so somehow the Hospice company has to make money.

And there is money to be made the honest way. I'm not criticizing these companies trying to make a living, I'm criticizing the obscene measures they take to increase profits. IMO, especially hospice, serving the patient should be the first priority. There are plenty of people out there with 6 months or less to live, these companies should be focused on finding a way to get to these people so that they might benefit from the hospice philosophy, and the money will naturally come with it.

[westieluv]

Corporate culture really has put a wet blanket on health care in many places.

You could always go back to acutes. :)

(ducks under desk)

Hahahahahaha...yeah...NO!

[edmia, BSN, RN]

It's all about that census in non-profits too. And cutting costs by not "encouraging" services like the HHA, extra equipment, same day delivery and the list goes on.

I do see case managers who order way too many supplies that are then wasted when the patient dies, but I always order what my patients really need. And I back it up with a good clinical note.

Hospice has the mandate by CMS to provide certain things. If the company is trying to not provide that, I fight it. I also don't admit patients who are clearly not eligible and I can back up my assessment with a good clinical note. A marketer is not going to dictate my ethics. But this is rare -- generally I can find documentation to justify eligibility.

The key is to know the guidelines and be able to justify your calls clinically. No one argues that.