Moderator ventana Posted April 3, 2014 Moderator Share Posted April 3, 2014 I have a primary care Geriatric house call practice Have dealt A LOT with hospice (2 agencies locally) other day one of them (the smaller one who I rarely deal with) said that I was not authorized to sign hospice orders. We are not talking about the certification here - that has to be MD/DO (stupid nonsensical rule but not the point of this post) but instead simple orders - i.e. INR management, medication changes, routine nursing orders. In my state the Doc has to sign the death cert so they have to notify him of the death as well - so admission and death have to be MD/DO but what are other people (PAs only in this case because NP has different regs on the national level) doing? This is not giving the order on the phone, but actually signing the written order following the verbal order - which gets faxed to the office a number of days later? Link to comment Share on other sites More sharing options...
eddoc Posted April 3, 2014 Share Posted April 3, 2014 Unfortunately Medicare doesn't cover physician assistant care delivered to hospice patients who are using Medicare's hospice benefit when the care you are delivering is related to condition that qualifies them for hospice. We ran into this when our geriatric service was trying to hire PAs and ended up having to use NP's (who are recognized by Medicare as "attending physicians") You can be reimbursed for any care that isn't related to their terminal condition. Link to comment Share on other sites More sharing options...
eddoc Posted April 3, 2014 Share Posted April 3, 2014 Sorry - realized I didn't really answer your question. Bottom line is in our neck of the woods, the work-around is just too difficult and PAs don't work in hospice. It isn't quite so onerous for palliative care, though and so they stick to that end. Link to comment Share on other sites More sharing options...
quarternote Posted April 3, 2014 Share Posted April 3, 2014 I ran into this in South Carolina while working as a hospitalist last year also. PA's hands are tied and not working in Palliative or Hospice. It was very disappointing for me. This is an area I am interested in working in and found a great deal of job satisfaction in. Luckily my SP was my friend and let me do a lot under her name. There is an association of PA's in Hospice /Palliative medicine that lobby for us. http://www.pahpm.com Sent from my iPad using Tapatalk Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 4, 2014 Author Moderator Share Posted April 4, 2014 But what about when I bill for my own services using the -GW (not related to hospice care Dx) Seems like if I am still the PCP then I should be able to sign the orders.... I am aware that a PA can not work in the delivery of hospice care (CMS does not pay) but in this case it is signing the order -no payment involved... Link to comment Share on other sites More sharing options...
quarternote Posted April 4, 2014 Share Posted April 4, 2014 I'm not sure about that. I know in S. C. Even if a PA/NP is the only PCP a Pt. has they can not order home health. Yet there some rural areas are only staffed with PA's as they can't get the docs to go there. Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 4, 2014 Author Moderator Share Posted April 4, 2014 vna different then hospice Link to comment Share on other sites More sharing options...
whoRyou Posted April 4, 2014 Share Posted April 4, 2014 vna different then hospice Is it different than palliative care? If so, what is the difference? I never heard of VNA Link to comment Share on other sites More sharing options...
primadonna22274 Posted April 4, 2014 Share Posted April 4, 2014 Hospice is true end-of-life care, requiring a physician's certification that a patient has a qualifying severe condition (cancer, dementia, end-organ failure, neuromuscular diseases for example) and is expected to die within 6 mos. There is a Medicare hospice benefit that pays a per diem rate (last I checked about $130-ish a day) to the hospice provider and in most cases the hospice must provide all services for that fee, including medications, oxygen, nursing care, medical equipment such as hospital bed etc. Palliative medicine has a much broader application and does not require imminent death. It is treatment expected to relieve pain and suffering but is not curative. PC can be terminal or transient--it can be for somebody with severe post-op pain even--or enduring, used in conjunction with hospice. There is indeed a lot of overlap (the specialty is Hospice and Palliative Medicine) but PC is not necessarily hospice, though hospice naturally incorporates PC. Link to comment Share on other sites More sharing options...
primadonna22274 Posted April 4, 2014 Share Posted April 4, 2014 I'm not sure about that. I know in S. C. Even if a PA/NP is the only PCP a Pt. has they can not order home health. Yet there some rural areas are only staffed with PA's as they can't get the docs to go there. And this is a HUGE problem in every state. One of the most significant barriers to effective use of PAs in primary care, especially those who have a lot of geriatric patients, and most especially to rural PAs who are often the ONLY health care provider for miles around. I know PAFT has worked very hard on this issue. It's actually one of the last straws that pushed me back into med school because I couldn't stand to not practice fully in a specialty that I had learned (much of it on my own in developing end-of-life curriculum for my PA program) and am very passionate about. Link to comment Share on other sites More sharing options...
quarternote Posted April 4, 2014 Share Posted April 4, 2014 Yes Ventana, I do realize that VNA is different than Hospice which is different than Palliative. **See PrimaDonna post**. It is an area that I truly loved working in. My point was we could not even write orders for Home health, much less work in hospice. You can provide other medical services for a hospice patient, but i'm not sure how the billing part works. Prior to being a PA I was a medical coder and did chart reviews but never did coding for hospice. Some PA's are retaining a doc just to sign orders such as this. PrimaDonna, I wish going to med school was an option for me. Unfortunately I'm not willing to put forth the effort at 54 to do it, then residency. I would be ready to retire when I finished. :(....Lately I keep thinking "If I could turn back time..." [that old Cher song] I like being a PA & like what I do, just wish there weren't so many battles [mostly political] to fight just to do my job. Link to comment Share on other sites More sharing options...
primadonna22274 Posted April 4, 2014 Share Posted April 4, 2014 I recognize I have had an opportunity that most PAs haven't and I plan to make the most of it. I turned 40 this year and I will most likely be working until 70-75. I'm ok with that. Also I don't have kids and don't plan to so I am able to be more selfish with my career. Link to comment Share on other sites More sharing options...
Moderator ventana Posted April 5, 2014 Author Moderator Share Posted April 5, 2014 There are a few issues which truly interfere with my practice. I am the primary care provider to approximately 200 homebound patients. The physician is a 1% owner, and will sign VNA orders. It is pure insanity that I'm not allowed to manage my own patients with my own signature. Then on top of this to be questioning whether I can be the PCP when they go on hospice is truly damaging to the patients. Disheartening to see the physician organizations fighting this so much. We should be able to offer these services to our patients. Link to comment Share on other sites More sharing options...
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