Antonia RN

Thank you.

We are not charging these patients, nor are we sending bills to Medicare. Some people we keep on as "charity" cases because if they go to nursing homes, which means a minimum of an hour drive for their family to visit, if they have transportation, they will be pretty well isolated. There has to be a way to address these types of clients because we see this happening more and more in the rural areas. I guess the plan is to just let them die so they won't be a "bother" anymore. We are able to get their doctors to sign orders, so we are not out of compliance as in working without orders.

So, we just "abandon" our patients because they have lazy or overworked doctors? In our case, we live in a mostly rural area and getting around is a challenge for a lot of people, expecially the elderly. What would you do - just "dump" them? We don't have mobile doctors here in the foothills in central Ca.

One is a patient who has a suprapubic catheter that gets changed q 3-4 weeks, and is a paraplegic. It is difficult to get him in to the doctors, plus, the office is not equipped witha lift, making it impossible for the MD or APN to do any real assessment! His MD has made one home visit - last year - and he was in a respite care center for a month and came home the end of March. He was seen by an MD both in the ER and respite center, but not his primary. He and his wife are in their late 80's. The other patient is a quadraplegic who has a very bad decub on his coccyx, weighs over 350 lbs and his family can't get him in a wheelchair. They have a lift, but the lift doesn't sit him straight in the wc requiring them to try and lift him into the seat. Not a good plan - can also cause further damage to the wound. Furthermore, his MD doesn't have a lift in the office either in order to get him on a table to be able to assess the wound. Now finally, the MD is working to get him approved for an ambulance transfer to the office, whereby he'll be on a guerney, allowing them to be able to turn him enough so it can be assessed. After informing the wife of pt #1 about the law requiring him to have face to face visits with his MD, she said she is going to contact the "handicapped" assoc and have them start some kind of push to inform doctors that they need to have appropriate equipment on hand to accommodate these kinds of patients! Can a visit by a NP or PA qualify as a face to face visit? Maybe the doctor groups need to look into that as a plan.

Our agency has a couple of patients who have not been seen by their primary MD for over a year now. The doctors keep renewing their medications and signing off on our orders and recerts. We are "threatening" to close their cases if they don't manage to get to their MD, or their MD come to them. We are sending reminders to the MDs about the law. It's getting down to the wire now for one patient in particular. How is this being enforced! What with patients going to hospitals and being treated by hospitalists (hate this) and still not being seen by their primary, what do you do?