High Cost Medications

[CapeCodMermaid, RN]

Do you all have a cap on spending for medications? We screen everyone coming in and usually say no to anyone on high cost Lovenox or high cost Zyvox....a 14 day course is about $4000. What SNF can afford that cost for one resident for 2 weeks of meds?

[hope3456, ASN, RN]

Doesn't the client or his payor source but the meds?

[CapeCodMermaid, RN]

If the patient is under a skilled Medicare benefit, WE pay for everything.

Medicaid covers if not on skill or some insurances cover, but since most of our admits have Medicare......

[Ruas61, BSN, RN]

Technically, you are not suppose to decline/deny Medicare because of medication cost. I would weigh the expected RUGS and the other components finances to help make a decision.

[CapeCodMermaid, RN]

Yeah ... We do that. Still hard to justify taking someone who is going to cost us $$$.

[Ruas61, BSN, RN]

Oh I know. I like the sneaky referrals that don't mention the hyperbaric treatments and such.

[Nascar nurse, ASN, RN]

I've been given a rough estimate of about $50/day for med costs. Like a previous poster said, we do weigh out expected RUG score - estimated length of stay, etc when trying to make a determination.

Just burns my rear when the Dr. orders that Zyvox within 24 hours of getting the resident in the door. In my experience the po Zyvox is way more expensive than the IV! One time had a Dr. order the medication on a weekend when I wasn't around to catch it. Called Dr. Monday morning and requested medication switch which he graciously agreed to when he learned the cost. I personally drove the remaining supply back to the LTC pharmacy to ensure we got the credit and it "didn't get lost in delivery".

[Havin' A Party!, ASN, RN]

Never understood how facilities can continually afford to take on residents with a multitude of meds... talking about over 20... on admission!

How do they stay in business???

[TBlase]

Never understood how facilities can continually afford to take on residents with a multitude of meds... talking about over 20... on admission!

How do they stay in business???

Constantly cutting staff pay, raising benefit costs, monitoring every staff hour on the clock and constant meeting to discuss those hours with the staff at every opportunity, constantly trying to scale back food costs, always trying to dream up ways to lure private pay patients, marketing gimmics (candy, flowers) to the preferred hospital discharge planners for the best (lowest cost) patients, constant meetings to determine ways to save on pharmacy overhead-such as meetings with the staff to hunt down missing meds or meds that haven't been charged out, asking family to escort patients to appointments, always trying to prevent being burned by accepting patients that end up becoming a nightmare by screening and then rescreening them before admitting them, the list goes on. Sadly, it's common to cut housekeeping in a lot of places when the census drops- the people that are paid the very least amount of money, but which keep some otherwise very nasty places in check. After all- if the census drops there are still miles of dirty floors, and still 50 or 100 toilets, for example? Also, it's not only medications- lots of treatment supplies are also not billable to the patient. Some of those things are outrageously priced, which leads to another attempt to control costs= constantly trying to get doctors to change orders (sometimes ussing subtle tactics, sometimes finding new doctors that are on the same page) to lower cost meds, treatments, and the like.

[AngelRN27]

What is the reason for their Lovenox therapy? When I worked at a LTC facility, anyone that came in on Lovenox had it dc'd within the first 7 days or was switched to Heparin (pending their first labs, of course). Most of them came with the order from the hospital for DVT prophylaxis, which apparently is not something we "treat" or "pre-treat" in LTC.

I guess this doesn't address the high cost med question, but I was just curious... is it only the facility that I worked for that does this?

[Havin' A Party!, ASN, RN]

Bridge to coumadin load-in.

[AngelRN27]

Interesting, I didn't know they used Lovenox for that purpose. I understand that the standard for this type of therapy is heparin as Lovenox is so short term.

Thanks