Wednesday, November 5, 2008

Just Keep 'Em Another Day

So I spent almost an hour on the phone with a family member trying to explain why it was a bad idea to send his dad to a skilled facility as a full code.

You see, his dad has been so severely demented as to be in the <3rd percentile for how long he'd already survived. Not surprisingly, when a big ol' stroke hit, he completely lost his ability to swallow. Solution? PEG tube. Let's just Terri Shaivo everyone.

What I had to further explain was that spit also has to be swallowed, and that it was only a matter of time before his dad filled his lungs with drool.

I'm good at these discussions. I really am. I have much better success than the average physician in getting families to do the right thing when it comes to code status and palliative care.

But this guy wouldn't hear of it. To paraphrase him, I was one in a long line of doctors trying to pressure him into killing his mom. He actually brought up Kevorkian. For once I was glad I was having this conversation on the phone with him.

So, after I realized that my efforts to procure his dad a humane end to his mortal coil were futile, I proceeded with discharge. Which was complicated.

So, total time spent arranging discharge, in this case, was truly 1 hour and 45 minutes. Since we have prolonged services codes, I asked our hospital coder what the threshold was for being able to add more time for a really long discharge. Surely, I proposed, that if it took 3 hours to discharge someone, I wouldn't get the same crappy 1.9 RVUs for that?

The answer, Dear Reader, is yes.

So, what I really wanted to do... but did not.... was to scratch this discharge day, get my damned prolonged services codes for a daily visit, and send him out the next morning.

It feels like that would be the wrong thing to do. At the same time, I just willingly screwed the Medicare National Bank's pooch.

No comments: