hospital admissions

[hcan]

I am the on call nurse for a hospital owned hospice, and we have run into a situation where the hospital is using the hospice for last minute "emergency admissions", very often after hours. The patient is admitted to hospice, sometimes even in the last minutes of their life, in order to protect the hospital's mortality rate. Apparently, the hospital benefits when the mortality rate is lower, and patients who die as hospice inpatients don't figure in to the rate. So we are doing the long admission process, and the floor nurses are having to change out charts to reflect a different billing process, which is time consuming and confusing for them, the patient is being disturbed by the transfer to a designated "hospice ward", which has no benefits for the family as far as creature comforts or additional room or chairs etc., and we as hospice nurses are frustrated by not being able to assist the family or the patient in the process that leads to a peaceful death.

Has anyone else any suggestions to help this situation? I try to bear in mind that ultimately improving the bottom line for the hospital is good for us, but on the other hand, we are a separate entity, and our staffing is not adequate to cope with the admission/death flood we have been getting.

[river1951]

It sounds ridiculous and stupid, if I understand you correctly. So they are transferring the patient to the inpatient hospice unit to preserve their stats? I get their rationale, but their hearts must be stone. It is different if folks are begging to die at home and we go out and admit for that reason even if the patient has a very short stay, they get something they wanted.

[Hospice Nurse LPN, BSN, RN]

What's going to happen when Medicare does a review? I understanding that sometimes folks die soon after admit (once during an admit), but so many must surely be a red flag for Medicare. And as you pointed out, that really leaves no time for working with the family. I'm confused as to why the admit/transfers aren't done earlier.

[doodlemom]

Unfortunately they are doing it for their own stats to look good but at least the families might have some bereavement support. Our hospice has "scatter beds" in the local hospital so there is no designated hospice unit. When we admit a patient in the hospital the patient does not move from their current bed. We are not owned by the hospital which is different from your hospice. We just have a contract with the hospital and we are frequently called in to do an admission for the same reason you are stating.

[aimeee, BSN, RN]

What's going to happen when Medicare does a review? I understanding that sometimes folks die soon after admit (once during an admit), but so many must surely be a red flag for Medicare. And as you pointed out, that really leaves no time for working with the family. I'm confused as to why the admit/transfers aren't done earlier.

That's an easy one to answer. When they are admitted to hospice the hospital only gets reimbursed whatever the hospice has contracted to pay them for the bed....which is probably the lions share of the inpatient general rate. This is probably about a quarter of what they can reimbursed by medicare if they keep their regular billing rates in place. Sad but true...all too often its about $$$ rather than supporting the family. Same thing happens in nursing homes that don't refer a patient until they figure out a way to make them fit the skilled criteria anymore. (And sometimes its the family's choice too because the way the medicare reimbursement is set up creates a financial disincentive for going from skilled care to routine hospice care)

[hcan]

Aimee, of course you are right. It would most definitely be in the hospital's financial interests to delay hospice admission as long as possible. Sucks for us!

[doodlemom]

Many of the patients that we admit have stayed in the hospital over and above their DRG days at the hospital so the hospital is no longer being paid by the insurance company or medicare. When we admit in the hospital they are getting at least some money - it is still a major loss financially to the hospital to keep the patient there. I guess for the hospital's finances it is better if a hospice owns an inpatient unit within the hospital and the patient is transferred to that unit where the hospice staff is taking care of the patient.

[mopnglo42]

Something that has helped at the hospital where I work is educating the doctors on hospice. A lot of them just really don't have a clue what hospice truly is or some of them see it as a failure when they refer a patient to hospice which have resulted in late admissions. The hospice dept hosted a series of presentations/seminars/events to help educate them and we are seeing results.

At least, with the hospice benefit in Ohio, the family will receive bereavement support for a year following the death of their loved one regardless of how long they were actually admitted to hospice.

[hcan]

I believe the year bereavement follow up is pretty is pretty standard. We also have it, but it must be pretty impersonal when it comes from a bunch of strangers. It seems that it would be much less meaningful than if the family had actually had some bonding experience with the hospice staff as their loved one went through the dying process.