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Discussion

Whose patient is this???? assistance please

My manager evaluated a patient at a local hospital on friday, patient appropriate for rectal cancer. pt had had home health x2 weeks (with physical therapy and occupational therapy each twice a week). She has been bedbound since christmas.

She agreed to hospice in the hospital setting, upon discharge-patient states she wishes to continue 2 pt visits a week and 2 ot visits a week (which my company will not cover-they will agree to a pt/ot eval-giving us guidance to formulate a care plan to help family/staff to help patient with pt/ot goals).

SO, i call the hospital to let them know that patient refusing hospice, wants to continue with home health with pt/ot 2x's a week. hospital states "she is not our patient." I call the home health company, "we need orders," i call the hospitalist, she refuses to give a home health order because "we ordered hospice," the oncologists' nurse on call said she would tell the oncologist, and he will call the patient on monday to facilitate her agreeing to hospice with just a pt/ot eval.

SO, has anyone else run into this? just because a patient qualifies for hospice intervention, it doesn't mean they will agree to services...... I've done this job for 4 years and have never run into this.:uhoh3:

Thank you

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    Your lil patient definitely needs to be seen by their PCP so they can discuss ( patient and MD ) what is available.

    I have run into this and it's always fallen back to the PCP. Once the patient is out of the hospital, the hospital and the hospitalists essentially wash their hands of the pateint. However, there PCP is where the order for HHA would come from or the Oncologist if the patient was seeing the patient prior.

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    • Author

    thank you.

    i don't know what my manager spoke with patient about. i would have thought scope of services would have entered into the conversation--as in pt had physical therapy and occuational therapy prior, and would this be continued with hospice.

    truthfully, i think all my mgr did was copy clinicals and fax to office. it did not seem that patient understood that services were changed from home health.

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    Make sure you clearly document this situation clearly from your side. CYA. I have had managers back pedal ans push the blame for patient revocation of services on the staff..

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    What a mess. I hate this type of situation. Clearly the scope of services was not clearly discussed and/or understood by the Patient/family. I like the idea of tossing the ball to the PCP.

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    • Author

    nurse for oncologist said she would be sure he called patient monday morning, to encourage her to accept hospice.

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    • Author

    UPDATE ON THIS SITUATION: Doc did not call patient. Doc said that "patient will be back in the hospital soon enough with vomiting and diarrhea...we will revisit hospice at that time".

    The bad thing is corporate is coming down on my manager like a ton of bricks because patient did not sign on service. BUT-better to NOT sign on service, than to sign up and revoke in 3 days to go back to hospital for symptoms.......

    just because patients MEET criteria-it doesn't mean that we are what they want.

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    UPDATE ON THIS SITUATION: Doc did not call patient. Doc said that "patient will be back in the hospital soon enough with vomiting and diarrhea...we will revisit hospice at that time".

    The bad thing is corporate is coming down on my manager like a ton of bricks because patient did not sign on service. BUT-better to NOT sign on service, than to sign up and revoke in 3 days to go back to hospital for symptoms.......

    just because patients MEET criteria-it doesn't mean that we are what they want.

    This is WHY it's called and ELECTION OF BENEFIT. Big corporations don't get it. It's the patent agreeing and wanting to be on service. an election of hospice benefit.

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