Help! What meds are not covered under hospice? - page 2

Our hospice has been advised that we may be paying for "unnecessary" meds that shouldn't be covered under the hospice benefit. We have always paid for medications related to the terminal illness and... Read More

  1. by   doodlemom
    Our hospice does not use Hospice Pharmacia but our emergency kits are brought out on admission if we know about the admission ahead of time (like the day before or if we're doing an afternoon admission, that morning.) We have our own pharmacy and our Medical Director writes all of the Rx's. If the patient does not get admitted, the meds are returned to the pharmacy unopened. If we don't have time to get one between referral and admission, one will be delivered later in the day. Our staff cannot just take one and assign it to a patient without the pharmacy having labeled it for that patient. That would be considered dispensing - which is something only pharmacists are allowed to do. Unfortunately our pharmacy is not located within our office, so the paks are delivered to our office 2-3 times a day. I like Hospice Pharmacia - I've used them before.
  2. by   nurselearner
    Is it possible to purchase the MUGS book from Hospice Pharmacia or is only for clients using their services?
    Last edit by nurselearner on Oct 15, '06
  3. by   KittyLoverRN
    In response to "aimee"....our nurses bring th comfort paks to the home upon admission...we keep a stock in our office....double locked of course!

    In response to "nurselearner"....I do not think you can purchase the HP manuals separately.....I believe they are only for those that partner with HP.:behindpc:
  4. by   doodlemom
    Kittlylover,
    Are the comfort paks not written for any particular patient? You are able to just take one - even if the referral has just been called in? If so, that is a much easier system. Who writes the Rx's?
  5. by   KittyLoverRN
    Doodlemom:

    The comfort paks are taken into the home upon admission. They are included in our standing medical orders, so when the admit is complete and MD is called for approval of orders (including standing medical orders), the comfort pak is okay to be left in the home. Doing it this way has really cut down on RN visits via on-call....we have a triage system in place and the triage nurses know if patient has a comfort pak or not. She/he is then able to triage the call based on the patient symptoms and the contents of the comfort pak! It's a much better system than we've ever used before!
  6. by   doodlemom
    We cover antibiotics in certain circumstances but not all. Our Medical Director makes the determination. If a patient has a foley and gets a UTI, it is something that we would cover. Not all UTI's would be covered, though.
  7. by   hospicemom
    Boy, this medication stuff sure is a tough one. Mostly when you hit the failure to thrive/debility and decline DX. Of course as stated before everything r/t dx.....however, we pay for everything r/t comfort as well....so, all pain, stool softeners are paid....If I had a CHF then lasix would be for symptom control. Even once we paid for a chemo drug because it was used as palliative to slow the tumor growth which was pressing on something causing pain.......so, really depends on the specific case. all antiemetics, antianxiety paid as well.
  8. by   saribeth
    We do cover all meds that are directly related to the hospice dx...even ambien (which does not work for our older pts and it is costly) Our comfort packs are $28 and THE BEST THING but we don't order them for every pt. Sometimes good ol' morphine ($30 for 30mls) lorazepam, and scope patches are all we need. When a pt has PAAD (discounted program in NJ) we give the pharmacist the # and we pay the $5 copay! All in all with the medicare per diem rate it is hard to break even on a lot of pts!
  9. by   chris_at_lucas_RN
    In re the earlier topic, we understand that if a patient is on hospice, all hospice meds come out of the hospice's daily reimbursement rate. There is Medicare D, and some other programs, but we are prohibited from using them since we are not the patient, and payment is our responsibility.

    As to meds, my understanding is that cardiac patients' cardiac, BP and cholesterol meds are covered. In addition, we would cover pain med, if the med was directed at a diagnosis-related cause (e.g., angina), but not if it was for something else (e.g., osteoarthritis). So we cover Dig, and the rest of it, but we hope to get a reasonable cost generic.

    When I came on, the previous PCC had been paying for everybody's everything. Just didn't care (or maybe didn't know). Our census was 22 and our med bill was $17,000 a month! I trimmed it down to just under $4,000.

    BUT--here's my question..... Since covered meds are diagnosis related, what meds would be covered with a diagnosis of "failure to thrive?" The patient has other diagnoses, but we are using this one because in Texas, for Medicaid patients (Texas Medicaid beneficiaries have a hospice benefit), there is something called a TILE (Texas Indicator of Level of Effort) which is a way of measuring the acuity of a patient and the relative care the nursing home staff must provide.

    Consequently, a patient who needs total care brings the nursing home a higher level of reimbursement than would one who is more independent. We could have taken an "easier" diagnosis (she also has CHF), but it would deprive the nursing home of some income and they are already annoyed that the state withholds 5% of their daily rate if a hospice is involved.

    So here we are, with the "failure to thrive" diagnosis, and no clue about what meds (other than the standard diarrhea, constipation, nausea and vomiting meds) should be covered. Help!

    TIA...!
  10. by   doodlemom
    [quote=chris_at_lucas_RN]I
    As to meds, my understanding is that cardiac patients' cardiac, BP and cholesterol meds are covered.
    BUT--here's my question..... Since covered meds are diagnosis related, what meds would be covered with a diagnosis of "failure to thrive?" The patient has other diagnoses, but we are using this one because in Texas, for Medicaid patients (Texas Medicaid beneficiaries have a hospice benefit), there is something called a TILE (Texas Indicator of Level of Effort) which is a way of measuring the acuity of a patient and the relative care the nursing home staff must provide.





    We do not cover cholesterol meds for any diagnosis. It's not treatment for heart disease and it does not promote comfort. If you all are paying for this, you could easily trim that out. For FTT and Debility Unspecified or General Decline, we pay for meds that are r/t comfort only - such as for pain, sob, anxiety/agitation, nausea, etc...We've been doing this for years and as far as I know, there is no rule that says you have to pay for anything else.
    Last edit by doodlemom on Nov 9, '06
  11. by   leslie :-D
    ftt is a tricky dx in hospice.
    typically it is multifactorial, with impaired physical function, malnutrition, depression and cognitive impairment being indicative of an adverse outcome.

    complicating this dx, often various meds and polypharmacy, can contribute to depression, anorexia, cognition and/or mental status.
    so by careful eval and elimination, ftt can be abated.

    the typical interventions include nutritional supplements, appetite stimulants, physical and occupational therapies, antidepressants and/or other psyche meds, etc.

    in the more unethical situations, little to nothing will be done except to 'let' them eventually die.
    so any meds administered r/t their dying process and systems affected, would be covered.

    it basically amounts to how much is going to be invested in reversing the process.
    often, all these measures have been taken and still, these pts can live long beyond the 6 month cutoff.

    much to consider in this particular dx....

    leslie

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