DNR question

[nord11]

If a patient is in ICU and they are made a DNR ( or was admitted as a DNR), does medicare pay for the ICU stay?

[RN1982]

Code status should have nothing to do with insurance billing. I've never heard of any patient's hospital stay not being paid for because the patient was made a DNR.

[nord11]

I am asking this because about 20 yrs ago in the ICU I was working in, the doc's got into trouble supposedly because they were putting too many DNR pts in the units and the hospital was not getting paid because of this. The pt usually did not meet the need for the critical care status once they were made a DNR. Don't know if this was actually true or not because I don't really care what or if they pay - I just take care of the patients.

[Straydandelion]

I don't think, though may be wrong, that the status DNR or not has anything to do with it, but more the status of appropriate level of care. In other words does the patient still meet ICU according to hospital standards of intensity of care, could the same care be done elsewhere? Medicare is usually billed by diseases, the hospital would get the same fee whether in ICU or another area of the hospital, so appropriate level of care is important in evaluating if the hospital can make a profit/come out even/ or loose profit. However a lot of times the secondary insurance which reimburses what Medicare doesn't depending on the policy may look at DNR vs ICU and deny payment for the ICU stay only allowing payment for stay on the floor if that is the level of care the patient is at.

[nebrgirl]

Wow, I didn't know that. A bunch of us were talking the other day, and decided that we would prefer to be DNR, since what I've seen is that the majority of folks they end up doing CPR on don't really turn out so good (quality of life is diminished)....but....this perhaps puts a new light on that discussion.

[kmoonshine, RN]

I don't think that DNR status would affect medicare payment if the pt requires ICU care. I've sent DNR pts to ICU because they required higher-level nursing care (chest tube and bipap, septic, etc); its just asking for trouble to send a DNR pt to the floor if they truly need ICU care (ratio in ICU tends to hover around 2:1; floor is 5:1 and up - its unfair to the floor nurses and puts other pts in jeopardy when nurses are tied-up with the one high-acuity pt).

I wonder if the docs you worked with were getting "in trouble" for sending DNR pts to the ICU because medicare reimbursement is terrible. So perhaps this was more of a "medicare" issue than a DNR issue.

[wooh, BSN, RN]

ICUs do a bit more than just "resuscitate" so even if they won't have to do that particular task with a patient, doesn't mean the patient doesn't require other ICU care. There's a lot that can be done for a patient prior to the need for resuscitation that just can't be done safely on the floor. I think people often get the impression (and sometimes I used to think so as well) that once there's a DNR in place, all that's needed is to hug the family and push pain meds. But that's very untrue.