Medicare Probe

caliotter3 · Nov 14, 2007

When something like this happens it is always best to read the handwriting on the wall and find that next job. I was laid off during a downsizing about 15 years ago. Management announced the layoffs. People started to leave of their own accord. Thirty per cent of the work force was gone in no time flat. One day several new hire CNAs walked off the job when they received their 20 resident assignments. Can you imagine what it was like for the charge nurses to try to do their own jobs as well as the jobs of the missing CNAs? That is what happens when there are layoffs. Do yourself a favor and start to look now. Don't wait for the pink slip. While you hesitate, your colleagues are out there pursuing what is available. Good luck.

Hellllllo Nurse, BSN, RN · Nov 14, 2007

When something like this happens it is always best to read the handwriting on the wall and find that next job. I was laid off during a downsizing about 15 years ago. Management announced the layoffs. People started to leave of their own accord. Thirty per cent of the work force was gone in no time flat. One day several new hire CNAs walked off the job when they received their 20 resident assignments. Can you imagine what it was like for the charge nurses to try to do their own jobs as well as the jobs of the missing CNAs? That is what happens when there are layoffs. Do yourself a favor and start to look now. Don't wait for the pink slip. While you hesitate, your colleagues are out there pursuing what is available. Good luck.

Excellent advice.

Daytonite, BSN, RN · Nov 14, 2007

This is the trickle down effect due to people in the office not paying attention to Medicare rules. Medicare does not do pre-authorizations. A facility is supposed to know the Medicare reimbursement rules. Apparently, the people who did the admissions and billing in your facility (the nursing staff isn't involved in this) didn't. Many facilities hire nurses or coordinators who are specifically trained in the Medicare rules and regulations to avoid this kind of thing from happening. The powers of your facility probably thought they were saving a few bucks by not doing this. Surprise! Medicare gotcha!

Sabby_NC · Nov 14, 2007

I work for what was formerly a large hospice (250-300 patients). Within the last 4-6 months, we have dropped over 100 of our patients due to a medicare probe...i.e. investigation of non-cancer diagnosis patients. We were told the LOS for most of our non-cancers was too high and so the powers that be have been discharging patients left and right due to being no longer hospice appropriate. Claims are being denied. This has resulted in major staffing cuts, etc. Has anyone else out there experienced this? Please give any details you know. I'm rather concerned for my job at this point. Didn't think I would ever be worried about my job in nursing!

Medicare has cut right back on this and we have been through h*ll with them.

We have the medicare guidelines as I am sure you have.

Loads of education has been given for appropriateness for hospice.

I forward plan and if any of my patients have improved and do not meet those guidelines, I notify the MD why this patient is no longer appropriate for our Services.

We do discharge but ensure that the pt and families are aware that we can readmit in a day, a week, or three months.

Once their condition starts to deteriorate, have an exacerbation of their COPD, CHF that require hospitalization.

Medicare is getting tighter and we are going to feel the sting of this. Trust me it will not go away.

We had a huge sum of money tied up with Medicare due to ADR's but are now getting that back. Been a hard road to climb but we have learnt so much through all of this.

I have little cheat cards that I use when I do each of my SNV's. I document those related to their illness in my narrative to show they are appropriate, whether it is with upper arm measurements, labs etc anything that can show evidence they remain appropriate for our services.

Things are quiet not only in our organization here at the moment but across the medical field including hospitals. BUT once the weather cools down watch out and get ready for the influx. Does this each year at this time.

We too have received an email about prn nurses will not be used and in our little office we have decided that once every one to two weeks one of us will take an extra day off with or without pay (our choice) until things pick up. Although we do have only 2 RN's and 1 LPN so it will not be too bad as our census for our wee office is not too bad.

So it will mean one extra day off every 3 weeks. Now that works for me :).

Hang in there things will improve. Organizations panic when this happens because 100 less patients means 100 less dollars (stretched and multiplied) is not coming into the coffers

doodlemom · Nov 15, 2007

we all know what the criteria is...Many time the patients may be appropriate but there is no good documentation to justify continued service. Also, I think what happens a lot of the time is that nurses get attached to certain patients and knows they will not get meds/good care if they are discharged, so they keep them on service. The team really has to be diligent in detecting if a patient is no longer appropriate. If you don't have good leadership, this can definitely go astray. To increase your agency's census by 100 could take quite a bit of time and it wouldn't be surprising if there were lay offs in the mean time. Are there other agencies in your area?

PeacePisceRN · Nov 15, 2007

I am in a metro area, and there are many other hospices in my area. The census has been hovering around 150 for about a month or so. There have already been significant layoffs in nursing staff (both RN and LPN nurses) as well as administrative staff. BUT, higher ups just keep moving higher up...in "restructuring" things. Seems staff nurses are disposable while managers and higher are just getting higher and higher.

doodlemom · Nov 15, 2007

I am in a metro area, and there are many other hospices in my area. The census has been hovering around 150 for about a month or so. There have already been significant layoffs in nursing staff (both RN and LPN nurses) as well as administrative staff. BUT, higher ups just keep moving higher up...in "restructuring" things. Seems staff nurses are disposable while managers and higher are just getting higher and higher.

It sounds like not such a great place to work anyway. I hope there is another hospice that you would be happy at. Good luck to you.

introspectiveRN · Nov 17, 2007

When something like this happens it is always best to read the handwriting on the wall and find that next job. I was laid off during a downsizing about 15 years ago. Management announced the layoffs. People started to leave of their own accord. Thirty per cent of the work force was gone in no time flat. One day several new hire CNAs walked off the job when they received their 20 resident assignments. Can you imagine what it was like for the charge nurses to try to do their own jobs as well as the jobs of the missing CNAs? That is what happens when there are layoffs. Do yourself a favor and start to look now. Don't wait for the pink slip. While you hesitate, your colleagues are out there pursuing what is available. Good luck.

:yeahthat:. Exactamundo.

tencat · Nov 17, 2007

It must be the 'flavor of the month' for medicare right now to be looking closely at hospice patients. We have also discharged quite a few of our pateints in the past couple of weeks due to the mess with medicare and our company admitting inappropriate patients for services, or keeping on patients who have not declined at all. From what I gather, hospice companies seeking reimbursement from medicare have abused the system, so medicare is getting tougher on enforcing criteria, etc. Everyone needs to be on the same page when admitting patients, and patients need to fully understand that if they do not decline, or if they stabilize they will be discharged. The marketing folks like to sugar coat it all and promise the moon (at least where I work), and therein lies the problem. I really like hospice, but I'm not too sure that 'for profit' and 'hospice' are such a good combination...... :nono:

req_read · Nov 18, 2007

PeacePisceRN…

Interesting, although no more surprising than the price of oil. Anyone reading the posts on this forum could see it coming.

From the data you have provided about your agency’s census, a reduction of 100 pts translates into roughly (conservatively) $12,000 less income per day… or $360,000 less income per month… or $4,320,000 less income per year. I think your management & administrative people are going to have to re-think their budget.

If your prior census was 250 to 300 and you discharged 100, then 33% to 40% of your pt population was inappropriate. That’s kind of a lot.

If your census continues to hover at 150 when it used to be 250 to 300 (average 275) your agency will experience a 45% reduction in its income. In other words its income will drop from $12,045,000/yr to $6,575,000/yr… which is a loss of $5,475,000 annually. Your volunteer department is really going to have to get going with some serious bake sales.

Now take these numbers and start multiplying them by the number of hospice agencies across the nation and you can begin to see why the folks at Medicare might be a little miffed.

Seriously PeacePisceRN, if you reside in a metro area where there are lots of other hospice agencies I would suggest you start looking around. Identifying pts that are appropriate for hospice can be tricky, that is true. But when an agency is wrong 33% to 40% of the time… well, you might want to start looking for an agency that is a smidgen more on the honest side. But then, statistical data shows that hospices have been drifting towards greed for quite some time now. How hard do you think it will be to find an honest one? And if Medicare is squeezing your agency isn’t it logical to assume they will be doing the same to all the agencies in your area? If so, there may be lots of unemployed hospice nurses looking for work and fewer appropriate hospice patients (now that appropriateness is being redefined more tightly) to go around.

Additionally, as this trend spreads (Medicare crackdown) agencies will be looking to cut their losses… or at least the ones who decide to stay in business. They will want to keep the most “productive” nurses, and let the others go. Translation: If you think case-loads are high now, stick around.

Have you considered OB/GYN?

Michael

PeacePisceRN · Nov 18, 2007

Have you considered OB/GYN?

Thank you for all your useful information. I think part of the problem is that any nurse on staff does admissions, and we are not all well versed in Medicare rules and guidelines. I do around 2-3 admissions per week, and I still don't understand all the regulations. I do my best, use my appropriateness worksheets, and if I have any questions, call the medical director to verify appropriateness.

As for OB nursing...NOT FOR ME!! :uhoh3: For some reason, I just don't think I could handle that. I was an ER nurse for many years prior to working with Hospice. It was a very hard decision for me to leave the ER because I absolutely loved it. :1luvu: But, now I love hospice and don't want to leave it. But, things will happen as they should. I don't carry a caseload. I work 16-hour on-call shifts at night. Even with a dramatic decrease in our census, the demand at night has not lessened. I just worry about the potential for change with the constant change among the primary day nurses and administrative staff. :confused:

Thanks again!