Critical access hospitals and billing

[Marinejiujitsu]

I think we can all agree that there's over ordering of labs and imaging. I'm curious how everybody else handles critical access hospitals that are at risk of going undet and having to close the doors
Do you order more then you usually would, or try to keep your standard of care and order how you usually would?
 
ERPA btw.
 
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[Marinejiujitsu]

Sorry phone typing. Meant to say critical assess hospital and billing

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[ohiovolffemtp]

There are only a few ways in which I've changed my ordering practices at my critical access hospital:

• Outpatient imaging: I typically order OP ultrasounds, because my only option at night is my bedside U/S.  In a few cases I can order OP MRI, because we do have MRI M-F days, like an overnight stroke with a low NIH score if neuro will be in that coming day.
• Labs: actually probably order slightly less, because some things are send-outs, which make them irrelevant for my EM work, unless the patient is going to be admitted.

What my hospital does do is have "swing beds" in which the patient is discharged but actually stays for inpatient rehab.

[Marinejiujitsu]

There are only a few ways in which I've changed my ordering practices at my critical access hospital:

• Outpatient imaging: I typically order OP ultrasounds, because my only option at night is my bedside U/S.  In a few cases I can order OP MRI, because we do have MRI M-F days, like an overnight stroke with a low NIH score if neuro will be in that coming day.
• Labs: actually probably order slightly less, because some things are send-outs, which make them irrelevant for my EM work, unless the patient is going to be admitted.

What my hospital does do is have "swing beds" in which the patient is discharged but actually stays for inpatient rehab.

I tend to order 1st dose antibiotics if we are not too busy. I order more IV fluids when people say they are dizzy too. My attending wants us to order more respiratory panels on kids. I tend not too as much unless the patient is being admitted or pertains to treatment and plan suck as flu or rsv in the infants.

I feel admissions with the attendings are turning a little watered down. Mild cellutis being admitted. Mild dka. Etc...

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[LT_Oneal_PAC]

No, I don’t order any extra and I am pretty minimalist. Only one person I know in my shop orders less than I do, but I think she is very “brave,” ordering only a lumber spine XR on 78 year old fall on ice with cervical tenderness and lumbar pain and prior lumbar surgery. I think I bill more than my colleagues though because of the way I chart and I chart critical care time, which they oddly never do.

[PickleRick]

Former CAH ER guy.  I ordered what I needed to support my workup, and no more.  Soft admits are the norm at a lot of small places.  I didn't dance on the edge.  Most times, I would admit to observation for IV fluids, and repeat lab if something was a little off on the initials.  Expectation was that the patient would be discharged if all came out okay.  Problem was, family med would frequently come in the next morning, and make the patient a full admit, with no criteria for the longer stay.  Some would say it helps keep the hospital afloat.  However, when the RAC would come in a few months later, and determine that the full admit was unnecessary, they would recoup the $14k or so in reimbursement the hospital had received.  I wanted no part of that business, and refused to bend the rules.

[ohiovolffemtp]

I do tend to order 1st dose of most meds as I work nights and the local pharmacies close by 8PM and the nearest 24 hour pharmacy is 45 minutes away.  We also dispense limited amounts of meds if they will need them before they can get to the pharmacy, usually 12-18 hours worth.

[rev ronin]

19 hours ago, Marinejiujitsu said:

Sorry phone typing. Meant to say critical assess hospital and billing
 

Fixed that for you.

[rev ronin]

Nope, I may give patients options based on THEIR financial situation. ("It looks very, very much like a common SK.  Normal practice would be to send it to pathology since we cut it off...") but never based on the practice's.  I do everything I think is appropriate, and I bill for all the services rendered, unless I'm not happy with my own work for some reason. Just did a cryoablation on a penis wart, went and looked it up, and the list price for that code was about 3% more than the generic wart destruction code... So I used it.