Productivity this!

“On the ground and give me 20, so we can meet our billing quota!!!”

This is another fun story from my time working in nursing homes. Don’t get me wrong, I have many fond memories of working there. Some people in our industry really like working in that environment. I would guess most do not. Most of us are naive and want to work in the “cool” orthopedic/outpatient settings. These can also be great, but sometimes the work becomes mundane.

There are many people in nursing homes who really need our help. That work can be very rewarding. I really enjoy asking people about their careers and military service. It is a fascinating history and perspective.

Some retired men act like 2 year old boys

At one point I worked in a very relaxed setting. Many of the residents wanted to work out early, and would show up at the gym doors at 7am. It’s always easier for us to help people who are motivated. We had a list of people to see for the day, and wanted to get ahead of the day. Sometimes we’d be done by 3:30.

But that wasn’t good enough for the bean counters, many of whom have never treated patients.

Medicare used to have this extremely tedious and confusing way of billing for rehab services in these locations. They usually employed a retired nurse to oversee this monstrosity. They were usually stressed out and frazzled, with a gigantic white board in their office, listing patients and billing unit totals. It was a game to see how many minutes could fit in certain brackets to maximize profit.

If a patient refused treatment one day, or didn’t reach a certain threshold, the home would not receive as much money for some of those treatments.

This led to highly unethical billing situations.

One day a regional manager told me I had to treat a 90 year old woman for 90 minutes. The woman was exhausted on this particular day, and refused. That is also a patient right, to refuse treatment (some industry managers will tell you they don’t have a right to refuse, as they are in a rehab placement).

I refused to place this lady on a table, place hot packs on her to trump up charges and extend the visit. I don’t know any 40 year old patients who can hang with the exercises for more than 60 minutes. It’s wasn’t about what’s best for the patient…

I responded with a letter describing the above mentioned reasoning, and started to talk about Medicare fraud.

I never heard another word about it.

I was 23 years old when I could be bullied into unethical billing. I’m now at the point in my career where I can start to push back, and argue my case, but can also be replaced by more “compliant,” and cheaper alternatives.