Should Patient be Revoked???

[AtlantaRN]

Im at a loss for this one. Alzheimers patient, still ambulatory, but declining intake. Started on Bactrim 3 days ago for foul urine and scant output...

Saw him today at 9am, stayed til 9:30...encouraged spouse to hydrate with water and cranberry juice, really push the water.....I get a call from my office at noon "they have called 911..." Family said "he passed out, and we got scared...he isn't acting right."

Corporate is telling me to revoke this patient, he is still in the ED. If we didn't authorize the ED visit, I don't think we have to pay for it. ((((Dollars to donuts, i'm certain it's the UTI)))).....

Opinions??? Advice...

Thanks!

[mc3, ASN, RN]

I agree with RNKittyCat - this may need a new title but I've had pt's who revoke and come back so many times it annoys me. It seems they want hospice for the extra nursing and HHA assistance, but aren't ready to hear that nothing more can be done for them. And, or course, the MD's and hospitals aren't exactly honest with them. Just curious, too. Do you work for a profit or non-profit hospice?

mc3

[a21chdchic]

6-26-2007

It sounds like your Hospice is "for Profit'? That would be why your marketer is getting ugly.

As far as revoking goes, we let patient's/families know upon admission that if they choose to seek treatment outside of the realm of 'Hospice', that they will need to sign papers to revoke Hospice so that medicare can properly be billed, otherwise Medicare will not pay for the Dr. visit's and/or hospitalization. So it is important to notify Hospice ASAP to ensure timely care and proper billing. They are also instructed after that care is completed they can choose to come back on Hospice, but the admission is repeated.

Patient/Family can be the only one to revoke. Hospice may discharge with a three day notice to family after other care arrangements have been made to ensure continuity of care.

'Not for Profit' Hospice's usually do not have 'copays'. It sounds like patient would qualify for a 'respite' stay for 5 days in an inpatient facility, and that should relieve the patient/family of the copay.

Can your social workers work on appropriate placement of this patient?

Ana

[youngheartoldhead]

From the Office of Inspector General

http://oig.hhs.gov/authorities/docs/hospicx.pdf

From page 5 of the document:

"The OIG has also been alerted to improper utilization of services that occurs when a hospice encourages a patient to revoke the Medicare Hospice Benefit for the purpose of obtaining expensive care under the standard Medicare benefits, only to re-elect the Medicare Hospice Benefit when expensive care is no longer necessary. "

AtlantaRN. The situation you describe obviously falls into this category. They pushed for the revocation and are clearly waiting to scoop the patient back up again. That's if some other vultures don't get to him first. I wouldn't be a part of that circus.

[AtlantaRN, RN]

AN update: The wife signed revocation papers, the patient stayed inpatient for 7 days, ended up with a peg tube. While inpatient, the family interviewed every home hospice agency in the state, it would seem; to see if they could get any more than 5 aide visits a week and 3 RN visits a week....as no one would offer more, they wanted to come back to the company I worked for. My administrator refused to readmit this patient as they used respite for a week each month (it seemed), and sought aggressive treatment without notifying hospice.....

just an update: I noted this was 2 years ago....

linda