Hospice and EMS

[Don1977]

Medicare is a joke, Ive had patients near death and they wanted a CMN (Certificate of medical necessity)..... You would think respiratory failure is a good enough reason....

[crotchitymedic1986]

Well it would be Don, if we did not have a corrupt wheelchair van/dialysis transport industry that is full of fraud.

[Don1977]

Well it would be Don, if we did not have a corrupt wheelchair van/dialysis transport industry that is full of fraud.

I agree, my old company was not innocent....

[island emt]

You may not give a damn about the billing issues, but the pt's family might. They are soon going to be planning and paying for a funeral and now have medical bills on top of it.

tcripp, I don't know the answers but I don't think it will affect medicare paying the bills. As island stated, just because they are on hospice does not mean that they don't get treated. The best thing to do is to ask the pt what they want done.

If the hospice folks don't want us to treat and transport when medically necessary , then they need to have medical directives or POLST orders for us to follow. Our state has a standardized DNR form and protocol that we can follow per the pt's or families wishes. We have been visiting this Pt's home repeatedly over the past several months and it's usually a lift assist and put back to bed or clean him up , change his pajama 's and back to bed. He gets a thorough eval on each & every visit.

If the hospice folks don't want us to respond , then they need to have someone there to take care of the Pt's.

I will not allow someone to suffer if we can help resolve an emergent issue.

Kinda like the discussion I had with a case manager from hospice when I showed up at the home of a pt who was bedridden and was developing skin breakdown. His wife had called me and asked if there was anything that would help. I happened to have an alternating air mattress in our lending library of equipment, so I brought it to the pt's home. The nurse manager asked me why they hadn't supplied that item.

I looked her in the eye and asked the same thing.

[2wheelinemt]

Last sat night me and my crew were dispatched to a residence for an unconc pt. En route we get an update cardiac arrest. Dispatch tell us that the Family does not want to do CPR. As we arrive We grab all of our equipment (defib,suction,etc). As we walk into the home the family is standing in the living room, the pt is in the back bed room! Only one person is in the room with her and we try to ask her some questions of when she was last seem, her med hx anything! My partner checks her pulse, gets to move her to the floor off the bed to start CPR. I ask the family in the living room if she has a dnr? The family states no! I state did she want to have CPR performed? Any heroic measures done? They state yes do everything. We start CPR. The pt is in a Non shockable rhythm. Our Pd was on location (they are a great bunch of guys) they helped us move her on a back board and carry all our equipment to the rig. As my partner and the policeman are carrying her out I again ask about hospice and a dnr. Why was I so sure that she was a hospice pt? I saw the wheel chair with the hospice name on it, the hosp bed with the name of hospice on it. They meds with the name of the pharmacy and hospice. She was a 98 yr old female. Extensive med hx. Fluid so thick in her lungs, that it was very hard to bag her. I again asked them, did she want to have everything done? Or did she just want to stay home and not having a tube down her throat, someone pushing hard on her chest? They stated yes do that and take her to the hosp. You're kidding me right? her! We had my dad on hospice,( which he lost the battle to cancer just recently). So I know how hospice works. If you are on hospice it is mandatory to have a dnr. For the sake of your Ins. What Medicare/Medicaid will and won't pay. They won't pay for any CPR, ems transport, etc. These people didn't produce the dnr. So we needed to work her. I was very much enraged. The family didn't take their eyes off the tv. They were not wanting to give my partner any pt info. This poor lady wanted to just go peacefully, instead the family seemed to us that they didn't want her lying there in the house waiting for hospice to come. They wanted us to just remove her. So calling 911 was a way to make that happen. How frustrating! My crew ( we have 2 trainees with us ) they were worried that we did something wrong. I explained to them that if they didn't produce it state law states we need to act. Has anyone come across this not the dnr and not producing it, but the fact they just wanted her gone from their house!? Leaves me very angered.

[Bieber]

Don't know too much about the payment system regarding that, but like ERDoc said, the patient has to make that decision themselves. With hospice patients (and really any patient), I think that we have a duty and obligation to inform them of their options, encourage them to go to the hospital if they need to go to the hospital, and in general do our best to give them the power to make an informed decision and unfortunately sometimes the answer is "I don't know". Erring on the side of caution is always a good bet to make, though.

[2wheelinemt]

The area that I am from as stated several times before by people if hospice didn't call the ambulance then those bills are on the family. Hospice has there own ems squad they call, their own er..for us if was a hosp that was appx 40 minutes away. We were told several times when we placed my dad on hospice. To call them for every little thing. Don't call your family doc..don't call your cancer doc. Call us. We are your pharmacy, your doc, etc. It's hard to get used to due to they way we are use to doing things. If we called no only would we have to pay the hosp bill,amb bill but we would need to reapply to hospice, hospice would need to reapply to Medicare for hospice coverage. So may of things are involved. But most of all hospice let's you know. They tell you every visit to call then. What the proper procedure is for the family and the pt on hospice. But hospice. Means you are terminal, so unless you want to be in and out of the hosp..which would mean no hospice. I just see some families calling 911 to have the pt removed from the house. You are suppose to call them, they come out, they call who you picked to be your funeral director when you signed onto hospice. They call and handle everything. But this one family wanted their family member out of the house they didn't call hospice till we were at the hosp. It was clear to us what was going on. Made me very upset that was the PTS last wishes and that couldn't even be followed!