When 'soft' admissions become fraudulent

[Guest ral]

Will try to keep it short. Colleague admits elderly patients to the hospital with diagnoses such as pneumonia, dehydration, or urosepsis. Frequently, the admissions come prior to any investigative studies. Problem? Clear chest xrays, normal white counts, urines that don't even require a micro, electrolytes and renal function better than mine. They stay three or four days, then back to home or the nursing home. He considers it to be "helping the hospital stay afloat" (small rural facility, frequently teetering on financial collapse). I consider it fraud. I've even been pressured to admit patients from the ED who have absolutely no findings, in spite of the nursing home sending them over because "they're lethargic" or "they had a temp this morning". Do you see this in your area?

[tcd1976]

That sounds like something straight out of "The House of God!"

[marilynpac]

Yep, it's fraud but it goes on all the time and if you question the doc you can bet the doc is going to b/c indignant and question you questioning him. I've seen it over and over not just in small hospitals but large ones too. Patients get admitted for 24hr observation. I do have to admit the patients that come from LTCF, they sometimes are a lot more ill than they appear and better to be safe than stuck with the almighty lawsuit. In the end you can just say you were being safe and sure.

[ventana]

a different perspective - we used to admitt people to the hospital just to give the family a break - birth of a child would be a 1-2 week admission, we would admit people to make a work up easier. Now with DRG's and micromanaged care have we swung to far the other direction - only wanting to admitt the sickest of the sick?

 

If a rural hospital closes does it help anyone? Is an admission a black and white decision?

 

I have been in ER's where mostly the hospitalist only wants to d/c patients and no interest in admitting and that stinks worse.... so if it is crazy obvious that the patient should not be admitted just d/c them before the call it made. If there is any wiggle room then take it and admitt the patient. I think sometimes PA's are insulated from the financial pressures that are placed on Doc's by administration and the need to make payroll/pay the bills.

 

You have to be able to sleep at night but don't be to quick to jump on a bandwagon....

[fyrelight74]

Don't you think a lot of 24 hr observations and such is simply to CYA?

[sbellin]

I have only worked in a rural critical access hospital and DRG’s don’t apply to us. If we tried to live on DRG’s we’d die. Maintaining critical access hospital status is based upon following lots of rules, there is a whole book of them. Is the admission justifiable, does the patient need IV meds, are there electrolyte abnormalities, is the length of stay justifiable? I’m told that in the past critical access hospitals have missed the crosshairs of Medicare surveys; now though more than half of the countries hospitals are critical access and so they will come under closer scrutiny. Penalties can and have ranged for the facility from loss of status and most certainly return of payments; closer to home personal financial penalties to the provider(s) involved. We have a team that daily reviews patients to make sure they meet criteria. There are soft admits and there are fraudulent admits, it sounds as if the latter is what you refer to.

[ventana]

geez I just wish the ER would work up for PE instead of d/c home on a zpak and pred when I send a patient in with o2 sat in the mid 70's, tachy 30 tachy 130 and febrile 102.....no lie - negative CXR and sent home....... would yeah, was not comfortable with that call from the ER - called the patient and told them to go back in....