nursebitback

This was what I read that made me ask those questions: Tencat!!! about 13 of our patients have General debility as a dx. (uh oh) http://oig.hhs.gov/fraud/docs/alertsandbulletins/hospice2.pdf Specifically, the Advisory Bulletin highlights several practices which indicate that some hospice providers may have inappropriately maximized their Medicare reimbursements at beneficiary expense. These practices include: Making incorrect determinations of a person’s life expectancy for purposes of meeting hospice eligibility criteria; Encouraging hospice beneficiaries to temporarily revoke their election of hospice during a period when costly services covered by a plan of care are needed in order for the hospice to avoid the obligation to pay for such services. Once a Medicare beneficiary elects hospice care, the hospice is responsible for furnishing directly, or arranging for, all supplies and services that relate to the beneficiary’s terminal condition, except the services of an attending physician. Hospice beneficiaries have the right to receive covered medical, social and emotional support services from the hospice directly, or through arrangements made by the hospice, and should not be forced to seek or pay for such care from non-hospice providers. The Office of Inspector General also has uncovered situations where duplicate claims were submitted by a hospice and other providers (such as skilled nursing homes and hospitals) for services related to the beneficiary’s terminal illness. In a nationwide audit of services provided to Medicare beneficiaries enrolled in hospice programs, approximately $21.6 million was improperly paid to hospitals and nursing homes for the treatment of hospice beneficiaries. Hospices are required to make financial arrangements for hospitalization, nursing services and all other health care needs related to the beneficiary’s terminal illness and included in the hospice plan of care. The cost of these services should be paid by the hospices. • A beneficiary has a right to expect a hospice to provide complete and accurate information about the consequences of hospice election and revocation. A hospice is obligated to inform beneficiaries or their representatives that by electing the hospice benefit, they waive all rights to curative treatment or other standard Medicare benefits related to the terminal illness, except for the services of an attending physician. Some hospices inappropriately induce beneficiaries or their representatives to enroll in the hospice program without explaining that hospice election results in forfeiture of curative treatment benefits under Medicare. The Office of Inspector General also has learned of hospices which induce beneficiaries to revoke the hospice election if expensive palliative treatment, even for a temporary period, becomes necessary. As a consequence, beneficiaries may then be burdened with substantial co-payments that would not be charged under hospice.

I would say that a nurse has to be very cautious with taking charting advice from non-nurse types, but the truth is, a nurse has to be very cautious in taking charting advice from ANYONE other than her own internal internal voice. Let me take the blinders off for you less than informed ones. Negative charting doesn't mean charting exactly what you see. That is called charting the truth. What it means is that they want you to focus on the abnormalities and ignore the normalities. When the abnormalities are documented along with the normalities, a balancing effect occurs. If a patients pulse is 140, his respirations are 38, that seems pretty bad. But if you include the fact he just had the biggest bowel movement of his life and you walked up on him before he had a chance to pull his pants up, well, that sort of puts the readers mind at ease. The truth shall set you free. Which unfortunately sometimes means being fired from a home health or hospice job.

I'm new to hospice and don't know if this place is good for me or not. I'm not giving any identifying information, so I should be safe to speak on it here right? There were about 22 revocations within the last year. usual is about 50 pts census. All but about 3 of those 22 revocated were readmitted as soon as they got out hospital. Some of them have done this twice. I noticed they chart "revocation-seeking aggressive treatment", when they actually went in for needed care. They also used the term "outside plan of care" a good bit. This is on pt's with dx general debility and AFTT. The majority of dx's are debility, end stage heart, COPD, dementia, AFTT, CAD. Only about 7 have dx of cancer. The length of stays on some are long: 1 yr 4 mo dx CAD, 3 years dx ALS, 1 yr 5 mo lung CA, 1 year, 2 years dx CAD, 1 yr 10 months dx lung CA, 2 years dx general debility (nursing home). 2 years dx general debility (nursing home), 2 yrs 7 mo with dx of CAD, 1 year, 7 months, 8 months. and the longest being 3.5 years with a dx dementia. Is this okay ? They tell us that as long as they are considered terminal we can recertify them. Heck, I don't remember HOME HEALTH keeping pt's that long even.

thank you. another question- do you leave a copy of the plan of care in the patient's home? and a medication profile? I think home health has to do this but I can't find anything about hospice, I could easily be missing it though.

the rule that states you have to update the plan of care every two weeks, does it mean you have to update your care plan problems and basically rewrite them? the agency I work for doesn't make us do this and some of the care plan problems haven't been updated since june of 2008. Social worker's and Nurses too. They use computerized charting. I have started reading the regulations and when I told them about some of the things I learned, well, I don't think they like me anymore. I also told them that I think we may have a problem because there have been about 22 revocations in the last year with about 19 of them being readmitted as soon as they got out of hospital. Some have done this twice. They average about 50 patients. The more I read, the more I find things that I think aren't being done right? Is this possibly some sort of syndrome a hospice nurse gets when she starts reading the rules? such as maybe she is taking them too literally or maybe reading too much into them?

hubbys girl it sounds like some games are being played with you. do your best to not let them sideline you. travel50- "what in the world is wrong with this baby goat"...that is so funny!! thanks for that