Hospital policy?

[mom4josh]

In your hospital, do they allow another hospice to come to visit patients to solicit hospice? We have hospice services at our facility, and we we do in-patient, home, and nursing home hospice. Sometimes, however, when the docs order a hospice consult, the case managers call a referral to an outside hospice, rather than refer in-house. This doesn't seem like it should be allowed, as it is taking business away from us. Any advice or recommendations would be greatly appreciated!

[ErinS, BSN, RN]

Not only does this happen, this is a medicare requirement. You must allow pt's to have choice. I work for a large healthcare system, and actually most of our patients end up using other hospice companies. However, there should also be a policy to ensure case managers are not getting kick backs for referrals (which was happening at our company). We now do what is called a choice form and it has a list of agencies in the area. We can recommend ourselves, but can not say pro or cons about any other agencies. Then the hospice or homecare agency can come in, but only after choice is done (unless families are interviewing several agencies).

[tewdles, RN]

Sometimes, if a primary doc is not employed by the hospital, they may be the ones referring directly to a hospice which THEY prefer. Of course, the choice of a specific hospice is that of the patient and family alone, or should be.

[Hospice Nurse LPN, BSN, RN]

The pt has to be given a choice of hospice providers.

[traumaRUs, MSN, APRN]

Per Medicare and Medicaid guidelines, pts MUST be given a choice.

[SoCalRN1970]

it is a medicare requirement to allow patient to allow to choose their provider for hospice. To piegeon hole to refer to self is an issue and a COP. If found doing so, medicare cert can be pulled.

[mom4josh]

I understand that they must be given a choice. My concerns are when the case managers recommend another hospice or when another hospice solicits within the hospital. Sorry if I didn't make that clear.

[tewdles, RN]

Certainly hospices have marketing and professional relationships with hospitals. Just like hospitals have marketing and professional relationships with pharmacies and DME providers and other home care services.

Many times when given a list of hospices (for example) the patient or family are clueless as to which one is best or even good. They often will choose the hospice associated with the hospital, if that is an option. Patients, many times ask RNs or MSWs which agency they would recommend, an opinion that they are obliged NOT to give.

What they can say is that they have worked with a particular hospice before (or a lot or a little) or that they do or do not have any knowledge of them. The corportate objective is to limit the amount of personal opinion communicated in the professional setting, especially by nurses and social workers.

Unfortunately, however, that means that the real professional knowledge and wisdom that these professionals have cannot be employed to assist their patients in making decisions that may significantly impact their health status outside of the in-patient setting. That is precisely what the RN at the hospital is supposed to do, especially if working in a case management position...optimize the choices and the outcomes.

Because we, as nurses, are so inconsistent in our professional practice in this area, our superior respondents do not trust us with the responsibility. There are too many that would gladly pocket $$ for referrals to a particular agency or company. Happens all the time in fact.

Physicians are also guilty of this, sometimes on a much grander scale. But any crimes there would be more legal and less employment related me thinks.

Bottom line is that RNs and MSWs sort of have their hands tied to make wise recommendations, the docs not so much and we must depend upon them to guide our patients to the best care in the communities.

[tewdles, RN]

Was that just chemo brain or did it make any sense at all? lol

[curiousauntie]

We have a hospital in my practice area that has their own hospice. They do not allow us to do hospice visits to our patients who happen to be there (and it is a large hospital with 2 campuses that is the "closest" one to 75% of my patients). We end up having to discharge our patients if they are admitted there as we cannot service them, even if the hospital diagnosis is not related to their hospice diagnosis. Our nurses (who wear scrubs, not street clothes) have been turned away at the entrance by security when they have tried to do a visit. They will NOT give contracts to any outside hospice (there are at least 10 that operate in my area) to enable us to do visits to our patients and rarely give referrals to outside hospices, unless a patient voices a strong opinion for another hospice.

Yes, choice is mandated by Medicare, but our patients in that hospital who are already on our service (discharged or not) tell us that the hospital hospice pressures them to use their hospice. And yes, we go the the ER when a patient goes there, we speak to the case manager/discharge planner at the hospital (going as far as asking our patient or family member to please call us and hand the phone to the case manager/discharge planner while they are in the room, and tell the case manager to speak to the hospice nurse in the presence of the patient and the family). We have still lost patients due to that hospital/hospice pushing (I call it poaching) the patient to switch.

[tewdles, RN]

Since the hospital will not allow you in, can you complete a transfer of care with the patient to cover the hospitalized time?