sweetsugar

I had a patient who met me drunk and naked at the front door every time I went to see him. I kinda drew the line when he pee'd on me, though.

11-15 patients a day? I call that "drive-by nursing". Sorry, just my humble opinion . . .

From personal experience, if the patient is A&OX4, oftentimes, nothing happens with the State. They will talk to the resident; and, if the resident feels okay with her environment, they are going to back out quietly. What happens to you is another story. Your current employer may see you as a "troublemaker". It oftentimes is better to tread lightly on these situations; some agencies place the almighty referral source above God sometimes. Just be careful with calling in the State. Just my humble opinion.

If anyone can prove that their OASIS answers are, indeed, being changed--I would definitely contact a Qui Tam lawyer. With regard to changing benign hypertension to malignant hypertension, this is a prime example of "upcoding" to increase HHRG scores--which increase reimbursements. Medicare views upcoding and making patients look worse than what they are as fraud. Qui Tam lawyers listen to what potential "whistleblowers" have to say and, based upon the evidence, decide whether or not enough evidence of fraud exists. The employee, whether still working there or not, then files a Qui Tam complaint with the Department of Justice. The Department of Justice then is forced to look at the matter, investigate the matter, and make a monetary judgement against the company--if warranted. If there is a fine imposed for fraudulent practices, the employee can receive 10% to 30% of any recovered monies. I made the mistake of calling the 800 Medicare number to report three different agencies that I had the luck of working at. One of those agencies received a $60 million fine in Sept of 2011; that agency and another agency I worked for--and called about--are involved in the House & Senate Finance Committee investigations that were just forwarded to the Dept of Justice. Also, nurses are protected by the federal Whistleblower's Act. I contacted a Qui Tam lawyer, after the fact, and he told me that had I contacted them first--his firm would have definitely filed a Qui Tam lawsuit on my behalf against the agencies I had worked at. I wish I knew then what I know now. Just something to think about.

KateRN is absolutely correct with regard to the OASIS collection rules by Medicare. However, 1) the weekend RN should have the option of completing a skilled nurse visit along with the consents and admission paperwork. Then, the RN picking up the case the following Monday can start and finish the OASIS (one clinician rule is met). 2) Otherwise, the weekend RN should have the option of starting the OASIS on the weekend and then following up Monday or Tuesday (depending on what kind of weekend he or she had on call) [one clinician rule is met]. As far as the 30-day turn around time, having to wait an extra day or two for admission paperwork is not going to put any home health agency out of business. What will, however, is what is going on with the Gentiva class action lawsuit regarding unpaid overtime (specifically dealing with unpaid travel time and unpaid pay for documentation in the home). I have it good grounds that the same lawfirm that filed the class action suit is now looking at Amedisys for the same practices. Just my humble opinion. As of the week of January 9, 2012, there are approximately 1100 Gentiva employees who have joined in the above-referenced class action. The Georgia state judge overseeing this matter, granted permission to the D.C. lawfirm to contact all employees (not just nurses) to inquire about their willingness to join the class action suit. These notices were limited to only those employees who worked for Gentiva from 2008 to 2011; seems like a lot of unhappy clinicians out there about unpaid overtime. Seems like a whole lot of clinicians out there that just can't seem to get all that paperwork done in the patients' homes.

I can relay from personal experience as someone who did call every other weekend at a rural home health agency--it was a nightmare. I do not understand why but it seemed that the worst of the worst patients came out of the hospitals on Friday and were admitted on Saturday. I had start of care visits that lasted four hours (e.g., one patient had 21 wounds that all needed measured. In addition, he had an ileostomy, colostomy, and draining fistula that all required care). Guess what, I had to go back the next day and do it all again as I was the "on-call" nurse. I would leave my house at 7:00 a.m. and, oftentimes, not get back home until 9:00 p.m. or 10:00 p.m. The acuity of the patients, the drive time, and screw-ups of hospital discharge planners made it absolutely crazy. Looking back--as a weekend on-call nurse--I would suggest trying to work out an agreement that the weekend on-call nurse does the admit visit with skill (including getting all consents and admission paperwork completed) during that weekend visit. However, on the following Monday--the regularly scheduled RN for that particular area can complete the OASIS assessment for submission. I don't understand why agencies beat up on the weekend on-call nurses and make us hate on-call so much by demanding that all SOC OASIS assessments be completed that first visit. Medicare guidelines state that an agency has five days to complete the admission OASIS. Oh, and for those that say "yeah, but we have to get the OASIS locked and submitted to Medicare ASAP to get paid"--bah humbug. After working in the field for almost four years, I became a clinical supervisor. I was amazed to see that there is a one-month grace period from admission that the OASIS has to be locked and submitted. When I questioned the nurse who was training me--she said "It's our little secret. We just tell the field nurses we have to have the admission paperwork in 24 hours so we are certain that we get it." Just be very careful about your decision. On-call during weekend in a rural setting home health agency can really burn you out and make you want to burn something down. I would probably (definitely) keep on looking for a different opportunity.

You might not be homebound if your nurse has to schedule your visits each time before 11:00 a.m. so that you can drive yourself to the casino for lunch and a little slot machine action

To all home health nurses who have ever felt pressured by office staff regarding whether or not a patient needs recertified or not, the attached MedPAC Report to Congress dated March 2011 should shed some new insight for field RNs. Also, to field RNs who have been sent out to admit questionable doctors' office referrals, the attached MedPAC Report to Congress dated March 2011 should also shed some new insight into this practice. The stress related to the above two issues has resulted in numerous RNs leaving home health nursing. While field RNs have continued to voice their concerns to supervisors regarding the requirement of "Medical Necessity" for home health services to no avail, it is comforting to find out that MedPAC (the governmental agency that monitors Medicare spending and makes recommendations to Congress) has taken note of the same issues. Home health RNs who feel uncomfortable admitting or recertifying patients who really do not qualify under the Medical Necessity requirement for home health services now can stand up to office pressure with adequate support when they, as the assessing RN, determine that home health is not warranted in certain conditions. I find it very interesting that at a time when Medicare is predicted to go bankrupt by 2017 if no changes are made in the system, that home health agencies (on average according to the attached Report) are making a 17.5 or greater profit margin. Meanwhile, they do not want to pay nurses an appropriate salary--and, pay-per-visit payment practices continue. Until proven otherwise, this Report indicates that home health agencies do have financial resources available to pay all clinicians for unpaid time they spend on documentation in the evenings at home. Just my humble opinion. I would appreciate only responses from those RN's who actually read the attached Report. Legitimate debate on these issues can only occur when those debating have all of the correct information before them. Go to page 195 (Chapter 8 - Home Health Recommendations) to see what I am talking about. http://medpac.gov/documents/Mar11_EntireReport.pdf medpac.gov/documents/Mar11_EntireReport.pdf

I agree fully with your last comment--if we are dealing only with skilled nursing visits. I would have NEVER left home health nursing if all I had to do each day was skilled nurse visits. However, home health agencies have drifted towards a nurse care delivery plan that involves RN's doing only the OASIS assessments, while LPN's do the skilled nurse visits. Depending upon what type of computer system is being used, I can most assuredly state that there is no way that a nurse could complete their documentation on an OASIS visit while at the patient's home. Now, couple 3-4 SOC, ROC, Recert visits each day (with no easy peasy skilled nurse visits to chart on) and it is really easy to see how RN's are taking hours of charting at home. Moreover, a lot of HHA have some kind of a turn around time on their OASIS visits (faster they are locked in to Medicare's system, the faster the HHA gets reimbursed). Also, I would like to point out that in Louisiana, RN's get $26.00 per skilled nurse visit and between $35.00 and $55.00 for OASIS visits. Now, let's say you have to drive 30 to 40 minutes between SNV (Louisiana is very rural), you spend 45 minutes to 1.0 hour with your patient (non-compliance is rampant in Louisiana--therefore, there are NEVER 30-minute visits) and you can see how your hourly wage goes way down. By the way, I don't understand how you came to your $40 - $80 hourly rate. Could you please explain? The only conclusion I came to is you have two SNV in one hour; do you not have to drive? If you are documenting your note in that timeframe, just how much actual "hands-on" nursing care can you provide if you claim you can do two SNV in one hour? Are we talking about "drive-by nursing"?

As I said previously . . . we will let the Department of Labor decide about that. As I recall--when I worked at the hospital, if I needed to spend extra time documenting after a crazy shift, I got paid for every minute of my shift. I did not clock out until I was completely finished. Seems to me there is some "gaming" going on with labor laws here. I don't think the Department of Labor is going to look lightly on agencies that were just found to have been "gaming" Medicare and taking advantage of senior citizens. Let the chips fall where they may . . . However, if I was an LPN--I would be looking into just how many hours a week I was charting at home to get the documentation done. Just for the record -- yes, it is feasible to complete your charting in the home or in your car. However, when the crappy charting does not meet Medicare guidelines for that visit to be considered "skilled"--that's when the importance of thorough charting becomes an issue. Before agencies start screeching about the quality of charting, just remember this . . . you get what you pay for. P.S. - when did paying someone for the work they produce become a "penalty". I thought it was considered "wages". Just my humble opinion.

We will just have to wait and see what the Department of Labor's viewpoint is on the matter of unpaid overtime. I believe any patient in the home would rather a nurse pay attention to them during the visit rather than trying to get documentation completed. It would be interesting to take a poll on here to see just how many field nurses are able to get all of their charting done in the home. Documentation is an administrative task--it is not direct patient care. By the way, the exempt status for nurses getting paid overtime only applies to RN's. To all of you LPN's out there charting at home and not getting paid for it--you may want to look into why you are working for free. Look into the labor law pertaining to exempt status to clarify this for yourself. LPN's must get paid for all overtime--period. That is non-negotiable.

Actually, just Google the following: Staff Report on Home Health and the Medicare Threshold. That will bring up the October 3, 2011, House & Senate Finance Committee's full report. Very interesting reading.

I did not realize that Gentiva had been fined for fraud. LHC in Louisiana received a $65 million fine in September 2011 for fraud. Both of these fines do not have anything to do with the October 3, 2011, report from the House and Senate Finance Committee investigation findings. That proceeding is now in the hands of the U.S. Dept of Justice. It will be very interesting to see just how large of a fine each of these companies (Gentiva, LHC, and Amedisys) has to cough up. I would even venture to say that some people from Amedisys are possibly going to be going to jail over their actions. If you would like to see some interesting stuff, just Google October 3, 2011, +House +Senate +Finance +Medicare +Home Health. I was amazed to see just how far some companies have gone to "game" Medicare.

This is going to be a rather strange post, I fear. I am taking a global health class right now in pursuit of my masters degree. The topic at hand is health disparities between wealthy and poor countries. Hundreds of thousands of people are dying in South Africa because they cannot afford the medication to treat malaria. The pharmaceutical companies are monopolizing the market and demanding a very high price for the medication. The pharmaceutical companies do not actually develop and patent new medications, university students research and develop new medications. The universities they attend obtain patents for new medications. The universities then enter into a license agreement with large pharmaceutical companies. The pharmaceutical companies are able to control how all countries obtain their medications (thus, prohibiting the use of generic drugs). The students of the universities are banding together in an effort to make their discoveries available to poor countries such as Africa and India (Aids/Malaria/tuberculosis). Their coalition is called: Universities Allied for Essential Medicines. Senator Patrick Leahy has proposed a bill (S. 4040) to decrease the power pharmaceutical companies have in how poor nations access life-saving medications. This bill would require a clause in licensee agreements between universities and pharmaceutical companies that allows the use of generic drugs in third-world countries. The bill is still in the Senate Judiciary Committee. Please, if you think that this is important, Google: Senate Judiciary Committee and send a quick e-mail to Senator Leahy stating that you support this bill. It is a shame that millions die (children included) due to a treatable disease such as malaria for greed's sake. Thanks a bunch!

Goodness . . . they are still selling that Scantron system? I wanted to poke my eyes out with that stupid pen by the end of the day!