Medicare Probe

Allow Mystery · Dec 5, 2007

Thank you Aimee, I hope you enjoyed The Big Easy (New Orleans). For you that have not been to The Big Easy, it is known for good food, jazz, Hurricane Katrina (which they'll never get over and quit crying about), high crime rate, a mayor that refers to it as "chocalate city", possibly a nice place to visit, but I wouldn't want to live there, and lucky to get out of there with your life.

I appreciate your input, and glad to here that you don't have an issue with the cap, will discharge patients who have stabalized, and have

an altruistic mission.

To borrow Michael's question, "Are they (your ethical agency) hiring?"

Best wishes!

mc3, ASN, RN · Dec 5, 2007

I would like to think that upper managers would read this board, but I'm afraid they have their heads stuck in the sand.......

mc3

medsurgnurse, RN · Dec 5, 2007

Thank you Aimee, I hope you enjoyed The Big Easy (New Orleans). For you that have not been to The Big Easy, it is known for good food, jazz, Hurricane Katrina (which they'll never get over and quit crying about), high crime rate, a mayor that refers to it as "chocalate city", possibly a nice place to visit, but I wouldn't want to live there, and lucky to get out of there with your

Please do not speak so callously of something you know nothing about. It's offensive. Get in your car and drive for 10 hours. Now imagine everything you passed on this ten hour drive is gone. Every house and building. All Bridges, schools, churches, businesses. In fact entire roads were washed away. Ten hours, hundreds of miles ....That is how far I would have to drive to reach outside of the area devastated by Hurricane Katrina and Rita.

Allow Mystery · Dec 5, 2007

Please do not speak so callously of something you know nothing about. It's offensive. Get in your car and drive for 10 hours. Now imagine everything you passed on this ten hour drive is gone. Every house and building. All Bridges, schools, churches, businesses. In fact entire roads were washed away. Ten hours, hundreds of miles ....That is how far I would have to drive to reach outside of the area devastated by Hurricane Katrina and Rita.

I'm sorry I offended you. I have lived in the New Orleans area (Kenner/Northshore) for 50 years, worked in the Central Business District for 20 years, evacuated for Hurricane Katrina, and came back, I'm familiar with the devastation two and one-half years ago; it doesn't change my humble opinion of the city as it is today, but once again, my apologies for having offended you. Best wishes!

req_read · Dec 5, 2007

aimeee,

Thank you for your comprehensive post.

Having run a hospice myself and worried about the cap, only to discover I could never get near it anyway (at least not so long as a modicum of integrity was employed) I cannot agree with you more. If the cap were a speed limit it would be about 220 mph. Would most people really have to worry about exceeding it on their morning commute to work? Or just those most blatantly disrespectful of others.

In the article suggested by multicollinearity

http://www.nytimes.com/2007/11/27/us/27hospice.html?_r=1&hp&oref=slogin

it was stated that some hospice advocacy group (I didn’t read through again to find which one) is lobbying for a 3 year moratorium on enforcing the cap. To me this is rather like a group of thieves lobbying for a moratorium on larceny convictions… not only to cover up what they’ve been up to, but also to allow themselves time to grab a little more.

Ultimately, this kind of attitude & behavior does hospice far more harm than good. With friends (advocates) like that, who needs enemies?

The greatest enemy is always within. Those in the best position to excise the disease are also within.

Also, isn’t it telling that hospice agencies that operate with a high level of integrity do not seem to suffer from the otherwise, almost universal nursing shortage. Neither do they have to worry about things like caps, bankruptcy or being shut down by State regulatory agencies.

How about it aimeee… are you hiring? (Don’t worry, I’m not asking for me.)

Michael

medsurgnurse, RN · Dec 6, 2007

I'm sorry I offended you. I have lived in the New Orleans area (Kenner/Northshore) for 50 years, worked in the Central Business District for 20 years, evacuated for Hurricane Katrina, and came back, I'm familiar with the devastation two and one-half years ago; it doesn't change my humble opinion of the city as it is today, but once again, my apologies for having offended you. Best wishes!

OK now I owe you an apology. Coming from someone who has lived in the city I can now say you do know what you are talking about. If you haven't been to the Gulf Coast lately everything to the Alabama border from blocks to miles inland was wiped out or flooded. And heading west everything to the Texas border was wiped out and/or flooded. That's what i want others to understand. Sorry I highjacked the thread.

aimeee, BSN, RN · Dec 6, 2007

Actually, Micheal, we are hiring. I think our only openings right now though are for oncall staff.

req_read · Dec 6, 2007

It boggles my mind that as high as (see the article in question… the figure varies depending on who you ask and what their motives are) 10% of hospice agencies are exceeding their cap. I really do not think that an agency could exceed their cap without actively trying to increase their average length of stay dramatically. The article gives the impression that some poor, picked-upon hospices inadvertently exceeded their cap. That is rather like saying, “I accidentally climbed a tree.”

Huh? How could anyone accidentally climb a tree? There would have to be some sort of intent involved somewhere along the line.

Further, it makes no sense to me that any hospice agency would be surprised to discover they had exceeded their cap. As previously explained, the math is not that difficult. If you ran out of gas and complain that it wasn’t fair one might well ask, “Well, did you look at your gas gauge?” Apparently there are quite a few hospice agencies out there that don’t check their gauges.

Why? This puzzles me. To break the cap you would have to be trying to break the cap. And if you were trying to break the cap, why would you not keep tabs on how close to the cap you were getting? Perhaps the answer lies in the degree of difficulty it takes to actually bust one’s cap.

Caps really are set quite high… so high in fact that some agencies may simply believe theirs cannot be broken… or at least if they do it would not amount to much of a payback at the end of the fiscal year. So they don’t even bother with watching their gauges, thinking their cap can’t be broken anyway. But through a combination of inappropriate admissions, inappropriate recertifications and ignoring the short-term (low return) patients they suddenly wake up to find they have not only broken their cap, they have also broken their own bank.

aimeee…

I would expect that with an agency and an administration the caliber of yours (assuming you are representative of your administrative team) your want-ad will attract more than enough applicants… perhaps even a few from this forum. Good agencies get the cream of the crop.

Michael

aimeee, BSN, RN · Dec 7, 2007

Unfortunately we have made some mistakes in the past. It takes a long time to build a great field team and management team. We went through a bad spell where we were doing a lot of reacting instead of sticking to one course. When you do that you don't get anywhere and it results in a lot of frustration and you lose the trust of your staff. We're making headway and I am hopeful for the future.

req_read · Dec 7, 2007

aimeee…

How refreshingly honest… an “administrative type” practicing the art of self-awareness. And how perfectly appropriate for a hospice nurse, since that is exactly what dying people experience (dying process forces self-awareness.) I am serious… I am truly impressed.

Hey, PeacePiscesRN & Allow Mystery… I know where there’s a good job… and its not in OB/GYN.

Michael

OneThunder, BSN, RN · Dec 17, 2007

Personally, I could never figure out why Medicare ever approved hospice in nursing homes in the first place. It is a classic example of double-dipping; i.e. paying 2 different providers for the same client. It must have taken some silver-tongued hospice lobbyists to talk legislators into passing that one. How much better off we would all be if national hospice organizations spent as much time & effort studying dying process as they do lobbying legislators, trying to figure out newer and better scams. There is no reason on God's green earth why LTC facilities should not be required to train their own nurses in the art of symptom control and teaching dying process to pts/fams. Well, I shouldn't say "no reason." Actually there are reasons why (some) LTC facilities don't provide good care to their clients, but those reasons cannot be described in polite language. I was opposed to hospice getting involved with LTC facilities in the beginning and refused to do it. Medicare is finally figuring out why.
CANRN...
Re: (quote) "Our hospice is non-profit and our marketer is convinced that the future is in nursing homes for hospice."
Your marketer is not exactly a mental giant. The whole concept is flawed... not to mention, on the brink of being shot down by Medicare.
Michael

Obviously, you have never worked in a LTC facility. The staff can hardly take care of the residents that they have, never mind a dying patient that needs extra assessments and care. Not to mention if the family is at the bedside.

req_read · Dec 17, 2007

OneThunder...

That is a separate issue.

Just as in the article in question, where a hospice nurse spends her day helping the elderly, rural poor manage their meds and turn sweet potatoes in the oven. That is all very nice and no doubt, necessary. However, hospice was not invented and designed for the purpose of turning sweet potatoes... nor for relieving nursing homes of the responsibility of hiring sufficient staff and training them properly.

Using hospice for something other than what it was intended damages hospice in the long run.

Michael