Liaisons/Non-Clincial..Never seen this before!!!!

BerryhappyRN, MSN, RN · Jun 1, 2016

Absolutely, positively true. You are just now noticing? Everything has become monetized, even death.

CHPNRNTX · Jun 1, 2016

I certainly know hospice is not what it used to be. But never have seen it involve so much illegal activity!!

nutella, MSN, RN · Jun 1, 2016

Ok, I have been in hospice for a very, very long time. I am seeing a new trend that is quite troublesome to me..Let me know if any of you are seeing this, and what is their explanation on how this is even legal:
NON-clinical liaisons/marketers...
1. Digging through a patient's chart and obtaining clinicals on patients and then witnessing consents without a RN eval for appropriateness?
2. Upon witnessing consents...leaving date blank or writing upon medical eligibility in the date line?
3. Receiving bonus incentives for admissions........?
4. Witnessing consents days in advance like sometimes a week, and then admission nurse admitting the patient?
When did this become legal/ethical?

yeah - it happens. I have seen non nurses go out and have the patient sign the admission papers with the RN coming out as soon as possible for initial admission assessment /care plan/teaching.

Hospice is a service that has become very competitive with marketing being a huge part of it.

toomuchbaloney · Jun 2, 2016

yeah - it happens. I have seen non nurses go out and have the patient sign the admission papers with the RN coming out as soon as possible for initial admission assessment /care plan/teaching.
Hospice is a service that has become very competitive with marketing being a huge part of it.

Isn't that illegal, at least in some states?

CHPNRNTX · Jun 2, 2016

Definitely should be!!! Conflict of interest

Jensmom7, BSN, RN · Jun 2, 2016

Isn't that illegal, at least in some states?

No, not illegal. Witness to consents does not have to be a clinical person. Our Chaplains and SW can witness consents.

Also, our liaisons DO NOT determine appropriateness for Hospice. The only thing they pull off of the computer is the face sheet. They talk to the family and/or the patient, and if they are interested, one of the nurses completes the LCD for Hospice eligibility, once the request for Hospice eval is put in (can't tell you the number of times I've had to track down the nurse to put in the order. Without that I can't legally access the chart).

The consent can be signed up to 2 weeks in advance. It is dated the day they sign. The Hospice start date can be left blank, because frequently the patient still has skilled days, or there is going to be a change in residence from facility to home.

Just because the consent is signed, that doesn't mean an automatic admit. The Hospice Medical Director has the final say. The evaluating nurse calls him/her after gathering the information, and the appropriate LCD is looked at.

Doesn't meet criteria? No admit, consent gets shredded, family and/or patient informed, patient can be reevaluated at a later date.

The Hospice start date is for billing purposes. That is the day that the patient flips from traditional Medicare to the Medicare Hospice benefit.

Believe me, if I had any reservations about the consents or any aspect of the process, from initial Meet & Greet to SOC visit, I would have gotten out of Hospice a long time ago.

Jensmom7, BSN, RN · Jun 2, 2016

Definitely should be!!! Conflict of interest

I don't think this means what you think it means.

CHPNRNTX · Jun 2, 2016

I completely understand what you are saying. But liaisons getting paid by the numbers of admissions they get seems like a huge conflict of interest. And the ones I am seeing ARE going into the charts and ordering meds and DME.

Jensmom7, BSN, RN · Jun 2, 2016

I completely understand what you are saying. But liaisons getting paid by the numbers of admissions they get seems like a huge conflict of interest. And the ones I am seeing ARE going into the charts and ordering meds and DME.

Marketers (and that's what liaisons have morphed into over the years) have always had productivity numbers to meet, and bonuses attendant on those numbers.

It still isn't their call. It's up to the nurse who evaluates and the Medical Director who had the final say.

That being said, one of the reasons CMS is tightening up on Hospice agencies is the staggering number of patients admitted with no real terminal diagnosis, much less meeting LCD criteria.

If you work for an agency that allows liaisons to order meds and DME (because we know there are even guidelines for Broda chairs, and liaisons tend to push them as an inducement. Don't know why, they're uncomfortable as Hell), and to do the eval (which must be done by an RN), you should probably reconsider whether you really want to remain with them.

CHPNRNTX · Jun 2, 2016

It's very very sad. Trust me!! I am running for the hills. The sad part is that these are the EXACT type of companies, who are greedy, has caused CMS to tighten the regulations so much, and making it hard on the ones that are doing the right thing. SMH

nutella, MSN, RN · Jun 3, 2016

I completely understand what you are saying. But liaisons getting paid by the numbers of admissions they get seems like a huge conflict of interest. And the ones I am seeing ARE going into the charts and ordering meds and DME.

I do not know what the situation is at your place but there are often agreements in place that liaison can access the chart as soon as a hospice evaluation is ordered. I worked as a liaison for a short time but I am a RN and I did not get paid per admission, I was salaried. I have worked with other liaisons who are not RN - but to be honest, most of them are RN because there is so much tied into the hospice evaluation. There have been cases when the patient was clearly hospice appropriate according to referral papers with supporting documentation and a non nurse would witness the consult to admit and order DME for example. In those cases the RN goes out next day and does the regular admission.

I am not sure why you are so upset.Some large companies have non RN because they are so huge and need non nurses to just market their business. For smaller businesses this is not reasonable in most cases and they use RN. As a nurse I had a harder time with the actual marketing piece so I can see that if the focus is on marketing that a non RN may be a better fit as long as they are ethical, understand the business and the scope.