At my hospital, our Foundation (fund raising department) has started what they call the "Circle of Caring". You become a member of the "Circle" by donating $10,000 or more to the Foundation. One of the perks of membership is "Healthcare Navigation Services" where a representative of the Foundation stays with you for the first 24 hours of your stay in the hospital starting in the ED. The names of the "Circle" members are flagged in our computer system and when they come in to the ED or are directly admitted we get a pop-up telling us to page the Foundation rep on call. They get taken directly to a private room and don't have to wait in the ED waiting area or in a multi-patient room regardless of their condition. The Foundation won't comment on it, but nurses have reported that they get seen much sooner by a Doc in the ED than they would have as a regular patient. I have had one of these patient's on the floor and the Foundation Rep basically lets you know, directly and indirectly, that this patient needs to be your top priority.
I realize the hospital depends on donations, but as a nurse it seems like we should be advocating for the seriously ill patient who is now having to wait even longer to be seen so that a big donor can have his "burning with urination" evaluated.
Is this becoming a new thing elsewhere in the country or is it just where I work?
This smells rotten. I have heard of similar programs. One Hospital actually had a special area for such members. One-on-One nursing care 24/7, and they were treated like royalty, regardless of their medical issue.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
In my experience (and I worked for several years as a hospital surveyor for my state and CMS, and enforcing EMTALA rules was part of my job), the prohibition on discriminating based on a person's ability to pay only applies to EDs and emergency situations. Hospitals are free to decline to admit or treat people for non-emergencies if they can't pay for the treatment, and there are no laws or regulations about who gets seen in what order.
However, in this case, the situation is not that anyone is being refused treatment; just that some people (with extra $$$) are getting some extra perks and consideration.
And JCAHO is such a racket -- they have no interest in anything that actually affects real, live clients and their care.
HOw true...How true!!!!!! but without accreditation from approved agicies....government monies dry up!
Absolutely but the patient bill of rights also states they cannot refuse care on the basis of ability to pay if they are receiving government money.
Specializes in Psych/CD/Medical/Emp Hlth/Staff ED.
They've been careful not to put this down in policy anywhere. A lawsuit is unlikely since the fact that a patient was escorted by a Foundation rep is not recorded in the permanent record. If a patient who stayed in the hospital at the same time as one of these patients did have a bad outcome, a lawyer would have to go through the charts of all the other patients staying in the hospital at the same time to make any correlation, which would be impossible without it being in the records.
We found out about this because Foundation staff were supposed to come to all the nurse staff meetings to encourage us to market the "circle" to patients. They were asking that we promote the idea and provide pamphlets to patients who we know to be potential large donors. On my unit, the Foundation rep only came to the morning staff meeting and did not attend the next two that day because the nursing staff's response at the morning meeting was "abusive", which only reinforced my faith in the Nursing profession.
In terms of CMS reimbursement, every patient still receives care at some point in some form, it just may not be equal.
As for the Joint Commission, they left shortly before this was introduced. Even if we get dinged for this, you don't need a perfect score to pass accreditation, you only need to pass.
We had a "VIP" room at a hopsital where I worked. Like the other nurses, it would irk me to be reminded of their VIP status. I prioritze by patient need not status. The only benefit of the VIP room was we once had an elderly patient whose son is in a very famous Rock and Roll band. It was hard not to be "star struck" seeing him in the room when going into check on my patient. I soooooooooo wanted to ask for an autograph but felt is wouldn't be professional so I went about my duties.
[/b]Absolutely but the patient bill of rights also states they cannot refuse care on the basis of ability to pay if they are receiving government money.
Which "patient bill of rights" are you talking about, specifically? There are scads of them "out there."
Also, again, no one here is talking about refusing care, the issue is prioritization of care and clients.
They've been careful not to put this down in policy anywhere. A lawsuit is unlikely since the fact that a patient was escorted by a Foundation rep is not recorded in the permanent record. If a patient who stayed in the hospital at the same time as one of these patients did have a bad outcome, a lawyer would have to go through the charts of all the other patients staying in the hospital at the same time to make any correlation, which would be impossible without it being in the records.
We found out about this because Foundation staff were supposed to come to all the nurse staff meetings to encourage us to market the "circle" to patients. They were asking that we promote the idea and provide pamphlets to patients who we know to be potential large donors. On my unit, the Foundation rep only came to the morning staff meeting and did not attend the next two that day because the nursing staff's response at the morning meeting was "abusive", which only reinforced my faith in the Nursing profession.
In terms of CMS reimbursement, every patient still receives care at some point in some form, it just may not be equal.
As for the Joint Commission, they left shortly before this was introduced. Even if we get dinged for this, you don't need a perfect score to pass accreditation, you only need to pass.
Do you all have any sort of hospital ombudsman, someone whose job it is to keep the place on the straight and virtuous path? If not and it really came down to it, I'd give serious thought to dropping an anonymous dime on the practice (with one of the pamphlets) to the local news organizations. Perhaps the Office of the Inspector General of the Department of Health and Human Services/CMS division could take a look at this? Even if all are receiving care, the government could end up paying more because people are being forced to wait for care - thereby worsening their conditions and requiring more intensive care and/or care over a longer period of time. That possibility seems like it might at least draw the office's attention.
Those are the best options I can think of when it comes to getting someone to take a hard look at this disturbing practice before it becomes so ensconced no one can change it.
I don't like the idea of clinical staff being asked to try to "sell" patients on the benefits of being a donor. However, I do think that it's reasonable to offer EXTRA services for higher pay and I don't think its unreasonable to offer EXTRA amenities to large donors if the money is used to help defray the costs for standard, quality care to others with fewer resources. However, if you have chronic understaffing due to financial constraints that threatens quality of care on a unit and then the hospital decides to spend money on personal assistants to big donors as opposed to improving staffing, that's a problem. If someone is "donating" money because they otherwise wouldn't get adequate care, then that's not really a "donation", is it?
After reading this, I am just curious as to what the mission statement and core "values" of this Hospital are. Money talks there, for sure. :barf01:
Whether we like it or not, the reality is that "money talks" in every US hospital. The way our healthcare system is set up, that's the only way hospitals can continue to operate. Even in non-profit systems, it ultimately comes down to money.
This reminds me of the frequent flier perks some airlines offer. I don't mind if they have a special lounge to wait in or if they get extra cookies and soda. But if they have better oxygen masks or they go down the escape chute first in an emergency (and get to take their carry-on luggage)--not so much.
Wonder what the hospital ethics committee thinks of this--or if they even know about it.
Flying ICU RN
460 Posts
The privileged class has been doing this sort of thing going back to the days of Lords and Vassals.
The only difference is that now we have a middle class serving two masters.