recerting too many times

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Specializes in med-surg,ltc,home health.

Do any of you feel that patients are kept on and recerted when actually they should be discharged?

I have worked for two different agengies in the last six years and it seems management wants you to find a reason to recert for as long as possible. I am feeling disillusioned with home health for that reason. It seems there is a fine line there where it is almost fraudulent.

Do any of you feel this way?

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Specializes in critical care; community health; psych.

I haven't run across this in HH but have in hospice. In hospice we held on to patients far too long.

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Specializes in med-surg,ltc,home health.

About how many certs does your average home health patient stay on? I recerted a patient today that has been a patient with this agency since 2004. I spoke with the patient and told her I would most likely have to discharge her at the end of this cert.

Her diagnoses are HTN, Sciatica and lower back pain. Her highest b/p reading was 150's systolic and 80's diastolic. No med changes. Her pain level was 9/10 when ambulating at times but 1/10 at rest.

She does need assist to bathe and we have an aide in twice a week for that but there is no real skilled nursing need you know?

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Specializes in Hemodialysis, Home Health.

We would DEFINATELY have to dc her.... if no other issues, nothing acute, no med changes, abx., no new acute dx., she would have to be dc'd... no way around it.

We, too, have some who have remained acitive with us for years, but usually they are fragile, and always have something new and acute pop up... or are on Vit. B12 injections Q month, and thus remain in the system just for monthly injections.

I know MCR frowns on keeping them if they are considered "chronic" with no changes.

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Specializes in LTC/hospital, home health (VNA).

I think that it depends on the reason for the numerous recerts. The patient you are describing I would think needs discharged and referred to office of aging or another appropriate community agency that can assist her with personal care needs. I know that we have a few "lifers" that our goal is to keep out of the hospital or keep free from infection or worsening. Like those chronic wounds that you know won't heal or seeing people every 4-5 weeks for catheters, but other than that-no. Our supervisors are pretty good at backing up our decisions. I would just tell your sups that you won't recert her b/c you aren"t gonna commit MC fraud...maybe they would like to go see her?

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Specializes in ICU, SDU, OR, RR, Ortho, Hospice RN.

Although I work in the Hospice field, if my patients do not meet the Medicare Guidelines, I do discharge. If I cannot show documented proof to back up my recerts such as weight loss evidenced by upper arm measurements, hospital admissions, treating infections in COPD's etc then we need to be vigilant in discharging.

Sometimes our patients come to us very sick, change the meds etc and bingo!! They improve :)

I am very pro active if my patients improve, I always am preparing the patients/ families for possible discharge.

In my line of work I don't get to discharge often. :(

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Specializes in med-surg,ltc,home health.

Thank you for your responses. My thinking is the same as yours.

The branch manager actually told us in a meeting to have our supervisor review our recert assessment.......... if we didn't find a reason to recert then maybe the supervisor could find something that we were missing!!!!

I have only been with this agency 3 months and I have discharged several.

Management gets very concerned with the census.

Oh and my supervisor's last day is next week. She was fed up with stuff too.

Yesterday I went out and did an admission on a patient that REALLY needed us and it made me feel good. I think alot of you can relate! Love the patients, but the politics and paperwork stink.

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Specializes in critical care; community health; psych.

I remember during my time in hospice, we were warned "no live discharges". This was the law handed down from census obsessed management. Wow. So when did corporate get involved in case management?

It was refreshing to be rid of that directive when I got into HH.

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Specializes in med-surg,ltc,home health.

I've never worked in hospice so I had never really thought much about hospice keeping people on that shouldn't be, but that does make since that some would improve and no longer meet the criteria for hospice. What a crude saying for management to tell yall......No live discharges!

I know your glad to be away from that.

I wonder if management worry that much about losing their license, or do they think they are above that? I guess us RN's at the case management level would be the first to get the ax because we actually signed off on it?

Does your home health agency really discharge in a timely manner? I would love to work for an agency that was run that way.

Oh,my supervisor that just left told me on her last day, the last straw that made her decide to give her resignation was when the branch manager "wrote her up" for the census decline!!! Not enough admissions and I guess too many discharges.

I discharged another one Monday......he was driving.

The branch manager is coming tomorrow for a mandatory meeting! woohoo can't wait for that!!:icon_roll:bugeyes:

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about how many certs does your average home health patient stay on? i recerted a patient today that has been a patient with this agency since 2004. i spoke with the patient and told her i would most likely have to discharge her at the end of this cert.

her diagnoses are htn, sciatica and lower back pain. her highest b/p reading was 150's systolic and 80's diastolic. no med changes. her pain level was 9/10 when ambulating at times but 1/10 at rest.

she does need assist to bathe and we have an aide in twice a week for that but there is no real skilled nursing need you know?

if there is no skilled nursing need, then the nursing assisance cannot stay, as aides must be supervised by an rn every two weeks per medicare regs.

the patient's blood pressure is controlled by her meds, and you cannot change the sciatica and back pain, except to provide teaching on her pain meds, repositioning, etc. which i'm sure has already been done many times. probably pt has also worked with her...nothing left to do...she needs to be discharged. :redpinkhe

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I've been on cases where I questioned the validity of the client receiving services. It does not surprise me to hear that there is such emphasis on getting a good census and keeping it high. I've also thought when I got on these cases where I thought hh was not appropriate, what would I do for a job if the patient were d/c? Since I'm not a salaried employee this thought crosses my mind. However, it doesn't keep me from discussing the matter with those responsible for recerts. My managers have only d/c for very obvious reasons and don't do that very often. Good example: the case where I was harassed (sexual). I would have d/c that patient in a heartbeat. There was much more going on there, including rampant Medicaid fraud, which was known to the agency. Now why do you think an agency would not d/c a ticking time bomb case? Why would they refuse to correct the unlawful behavior? Really makes one think.

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i've been on cases where i questioned the validity of the client receiving services. it does not surprise me to hear that there is such emphasis on getting a good census and keeping it high. i've also thought when i got on these cases where i thought hh was not appropriate, what would i do for a job if the patient were d/c? since i'm not a salaried employee this thought crosses my mind. however, it doesn't keep me from discussing the matter with those responsible for recerts. my managers have only d/c for very obvious reasons and don't do that very often. good example: the case where i was harassed (sexual). i would have d/c that patient in a heartbeat. there was much more going on there, including rampant medicaid fraud, which was known to the agency. now why do you think an agency would not d/c a ticking time bomb case? why would they refuse to correct the unlawful behavior? really makes one think.

unfortunately, for some agencies, even some considered "reputable," the $$$ is the bottom line, and stuff like this happens, way too often, in my humble opinion. however, fortunately, there are reputable companies that allow their case managers to decide if a patient is appropriate, either for an admission, or for discharge.

we all make our choices, to speak up or stay quiet, and for very different reasons. it's a matter of what you can live with, i suppose. but i'd rather take the high road, whatever the cost. :redpinkhe

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