To Discharge or Not

It is hard to discharge patients. It is especially hard when we feel like the patient really needs us. It also decreases census. The undeniable truth is that each time we discharge a patient, we are decreasing our revenue. And so we don’t discharge as often as we should.

Pretend for a minute that you are commissioned by Medicare to find claims that don’t meet the medical necessity criteria. What would you do? Do you allow agencies to hold onto patients because they feel protective of a patient who no longer meets criteria? Do you understand that agencies need to keep their census up to make ends meet?

Me? I would look at billing histories of agencies. Those agencies who had an excessive length of stay would immediately grab my attention. Next, I would request charts of patients who had been on service longer than two or three episodes. And I would make a ton of money.

Look at the data that you send when you drop a claim. You send start of care dates, diagnosis codes, and utilization information. If any of these numbers ‘fall out’, you are subject to scrutiny. Notice you do not send goals, or even visit notes to determine if services are billable. Chances are very good that if your patient has been on service for six episodes, at least one of the last three is not billable.

So, when it comes time to make the tough decision to discharge patients, consider if you really like having a Medicare provider number that allows you to bill Medicare for services. And if your census begins to drop keep in mind that front end marketing is the solution to declining census. Also, since early episodes pay more than later ones, your average payment per episode will increase meaning that you can maintain your income with fewer patients.

One of my clients had briefly employed a marketer who was recently arrested for DME fraud along with 38 other individuals from the surrounding area. Home Health agencies, DME companies and physicians were all involved. Of all the juicy details there is only one that struck fear in me. The marketer that was arrested had one five minute interview with a federal agent several months prior to her arrest. That was it.

This tells us that by the time a regulatory body (with the exception of state and certification surveys) arrives at your office, it is really just a formality. You have already sent to them the information required to build a case against you.

So, go out and find some new blood. Invest in ethical marketing. Empower your field staff to be marketers while performing their daily duties by educating them. Volunteer in the community. Improve the quality of your care to impress new referral sources. And while the number of admissions in a given month is important, it is even more important to capture information about new referral sources. Lots of referral sources will give you a chance but when that referral source refers three of more patients, you then have a new referral source. And that will bring new blood into your agency so that you can responsibly discharge your patients who have met goals.