Giving lovenox in LTC

[nurse yoda]

Edited due to fear of retribution by employer

[Daytonite, BSN, RN]

I believe that what is happening is that your facility is attempting to control it's cost for the medication. The LTC has to pay for all the Medicare (skilled) patient's medications out of the money that they will get from Medicare for each skilled patient. The pharmacy does not bill the Medicare patient for meds; they bill the facility. By keeping the Lovenox in one location it would be a lot easier for the facility to make one person responsible to keep track of who is receiving the medication. Then, the minute the patient goes off skilled status the Lovenox can be pulled from the patient's supply and any remainder sent back to the pharmacy for a credit. The pharmacy would then have to fill a new prescription if the patient is to stay on the Lovenox in order to bill the patient, who is no longer Medicare (skilled). The complaints from patients and families having to pay out of pocket pharmacy charges are ultimately the responsiblity of the administrators, not the nursing staff. Someone in administration will be responsible for getting an approval from a family member before anymore Lovenox is ordered from the pharmacy for a patient who is no longer Medicare (skilled). Physical control of the drug in one location would also be a way of preventing the medication from being given to another patient who is not Medicare (skilled); a lot of "borrowing" from other patient's medications goes on in LTC.

It does seem like a lot of extra work to take patients to one special location for just one medication. I have never heard of this being done before. I, honestly, don't think that giving Lovenox in the acute care area is Medicare mandated. I think what you're seeing is some administrator's "creative" idea of controlling pharmacy charges that he is accountable for. This sounds like penny pinching to the max. He's probably trying to cover his you-know-what with regard to budget and expenses.

[Spearfisher]

If the business office is making these decisions, then they need to find the loop hole to the madness [like having a roaming nurse assigned to the acute care out patient department or the treatment room in the ER (on weekends)] make rounds giving the shots. Your facility, it seems, is just trying to make ends meet and give the patients what they need. I wouldn't consider it fraud (they were told what hoop to jump through to get reimbursed). I wouldn't call it abuse. I do agree it's a waste.

[nurse yoda]

If the business office is making these decisions, then they need to find the loop hole to the madness [like having a roaming nurse assigned to the acute care out patient department or the treatment room in the ER (on weekends)] make rounds giving the shots. Your facility, it seems, is just trying to make ends meet and give the patients what they need. I wouldn't consider it fraud (they were told what hoop to jump through to get reimbursed). I wouldn't call it abuse. I do agree it's a waste.

Hi, thanks for the feedback, a "roaming nurse" wouldn't work. Initially the acute care nurses just wanted to come over to LTC and give the shot. We were told we couldn't do this...that the resident had to be physically taken to the ER or outpatient department. So I presumed from that, that they are charging the resident for an outpt or treatment room visit.

[Nascar nurse, ASN, RN]

From my understanding of medicare A skilled care in LTC, they (LTC) are reimbursed thru the PPS system depending upon the RUG score determined from the MDS. All resident expenses are paid out of this "balloon". This includes such things as all meds, dressing and Tx supplies, therapy costs, lab, X-Ray, etc, etc. There are a few exceptions, but very few (certain dialysis transports, radiation transports to name a few). Otherwise - EVERYTHING - is to be provided by the LTC facility. For example, if we have an outside provider come in and do an X-Ray, The X-ray company has to bill us - the LTC provider - not medicare (again, this is only for Medicare A skilled care). We had a resident that went to local oncologist for chemo (this is all a PPS exclusion), BUT the oncologist also administered Epogen during the visits. It took 2 years, but Medicare did eventually deny payment for the Epogen to the oncologist (as they were not the ones responsible for this charge) and then oncologist billed us a HUGE bill for 2 years of Epogen (OUCH ). The bottom line is that the LTC must be $$ aware or they will not survive - just like any other company you visit - if it continually goes in the red, it will have to close, BUT we also have to play by the rules. From what you've said, I think medicare will eventually expect the LTC facility to pay for the Lovenox despite by who or where is was actually administered. I don't know that they are actually trying to "cheat" the system, or if someone just doesn't understand they system. Good luck

[Bird2]

I have never priced Lovenox but the cost of paying an empolyee to transport a resident seems silly. Facilities usually make a decent amount of money on fxs especialy if they have PT and OT involved. If they accept the resident I feel they should accept the cost of Lovenox. They should look for other meds to save money on instead of a critical post fx med.