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.

[westieluv]

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.

Well, here is a sample conversation from our office this past week:

Marketer: "Okay, so go out and do the evaluation today, and then we can schedule the admission for this evening or first thing tomorrow."

Me: "Okay, but what if she doesn't qualify or her PCP isn't on board with hospice at this time?"

Marketer: "Ehhh, just leave all that to me. There are ways around everything."

...See what I mean?

[lifelearningrn, BSN, RN]

Insane! Census is important and making sure your patients remain eligible comes with the territory -but there are companies out there that put the patient needs first, and still profit- I work for one!

[angelbluern]

I agree as I worked for a hospice who kept patients on for two years and bent over backwards to keep ALF's on board regardless if the patient was hospice appropriate. That borders on fraud.

[edmia, BSN, RN]

Well, here is a sample conversation from our office this past week:

Marketer: "Okay, so go out and do the evaluation today, and then we can schedule the admission for this evening or first thing tomorrow."

Me: "Okay, but what if she doesn't qualify or her PCP isn't on board with hospice at this time?"

Marketer: "Ehhh, just leave all that to me. There are ways around everything."

...See what I mean?

Ugh! So frustrating I'm sure.

[Guttercat, ASN, RN]

Hahahahahaha...yeah...NO!

There are Acute programs set up right. You just weren't in one of them. The >cough

Corporate monopolies have something (a lot of things) to do with this phenomenon, because the Big Guys will do just about anything to win an Acute contract over a competitor.

It's tangential--if not outright parallel-- to what you are now facing in your new position in ....the politics of money. And they rely on the frontline workers sweep up the results of their decisions and hide their poo.

[ShesanRN]

Well, here is a sample conversation from our office this past week:

Marketer: "Okay, so go out and do the evaluation today, and then we can schedule the admission for this evening or first thing tomorrow."

Me: "Okay, but what if she doesn't qualify or her PCP isn't on board with hospice at this time?"

Marketer: "Ehhh, just leave all that to me. There are ways around everything."

...See what I mean?

Sounds like a marketer! Fortunately, I haven't seen ours try to weasel in unqualified patients - they seem to know better, and the nurses always seem to have the last say.

The most ours do is try to get a qualified patient admitted ASAP - before midnight of course! I'm thinking if they pulled anything like yours do in our office, the nurses would tell them to quit wasting time and energy they could be spending finding a qualified patient!

[Marshall1]

I recently left a home health agency that also has hospice and this was one of the reasons. While I understand wanting continuity of care for a patient and in many ways it would make sense to transfer a patient from home health to hospice or vice versa if they improved when the appropriate time arrived - if ever - but it was much like you described - and like you, I could not stomach it. Sadly, that experience has turned me off from wanting to work in home health or hospice.

[Nashvillejeanne]

It has been my understanding that "trolling", or digging in patients charts without consent or a consult request is not only unethical but breaks HIPPA HIPPA hooray regs...

Just something to think about.

[softrbreeze]

This is a problem with many hospices unfortunately and you may not be imagining it- there is ever stiffer competition for hospice patients. The area where I work is saturated with hospice companies. One hospice I worked for definitely employed some unethical practices and put pressure on me constantly to aid and abet. Even the company I now work for, which is more ethical than most, has from time to time ignored my statements that so and so did not meet criteria. It is a fine line we walk though. A patient may not seem to meet criteria simply for the fact that we are in there managing their care and are therefore relieving their symptoms. I don't think whether a hospice is for-profit or not-for-profit is of any bearing though. They both have employees to pay and overhead to keep. I've heard complaints about our local not-for-profit from patients leaving their services to come to ours that have really horrified me. Numerous people have told me they do not allow their patients to go to the hospital for any reason and force their patients to sign a DNR. One young woman with cancer was purportedly told she could not go to the ER for treatment after falling and breaking a leg. I take everything people tell me with a dose of salt but, if true, that is flat-out illegal.

[thekid]

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 $$.

Sadly this is true. I recently untangled myself from a psychiatric case manager after witnessing the circle of destruction. What better way to ensure a company's patient caseload than to keep them sick and dependent. This company had their own crisis center, halfways houses, group homes, etc. We were paid according to how many patients we had, not paid on quality of service or hours worked. What a sick incentive to keep those in the system. Sad to see hospice doing similar.

[thekid]

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.

How is it unfortunate that patients get better when they are under hospice care? That sounds so odd.