Ethical to bill healthy patients?

[Tromner]

I'm considering starting a side gig seeing acute rehab patients on the weekend at a local hospital as an independent contractor (billing patient's insurance directly without any hourly fee from the hospital). I would be expected to see all admissions and cover phone call for 24hrs.

One of the current docs says that he only sees admits and patients that the nurses flag as sick because he's not sure it's ethical to see more people, just to bill more. So he only works a half day, takes home less but still has to cover calls for the full 24hr shift.

So what do we think? Without seeing seeing the stable patients, I don't think the take home pay is worth the time/hassle/liability. In my residency, everyone was seen every day. I've thought about the questionable practice of up-coding but never really thought about "padding" my billing with healthy patient visits. I originally planned to do one weekend per month staying late to see (and bill) as many people as possible. Can I do that with a clean conscience?

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[RangerBob]

There are a few things to consider.

1) CMS requires at least 3 face-to-face visits per week from a physiatrist/rehab trained physician. If you’re not doing that, you’re not in compliance.

2) Not seeing a patient because they’re “too healthy” can possibly imply that they don’t meet medical necessity and perhaps don’t belong on rehab.

Our hospital requires we see patients at least every other day. So if I have a particularly busy day I triage things and see the sicker patients first, patients I made more important med changes in (for agitation, spasticity, etc), new admits/discharges, the ones admitted the day before, the ones going home the next day, then the ones that are stable.

If you’re covering call for the patient, and getting called by nurses about the patient, reviewing their vitals and any possible labs, I don’t see anything unethical about seeing the patient. You’re already doing the work and it’s fair to be compensated for that. Just don’t bill for a high level visit unless you do a lot of counseling.

I find my “healthier” patients still very much appreciate seeing me, and they often have lots of questions as well.

I certainly would never only see patients my nurses flag. I would absolutely see any patients they say I should see, but I would only not see a patient if I feel they don’t need to be seen.

Remember, it’s your license and reputation on the line. When I cover my partner’s patients I see all of them my first day covering, even if it makes for a long day. I’ve never met their patients, so the last thing I want is a call in the middle of the night from an RN saying “so-and-so’s <medical issue> is a bit worse today” and have no idea what the patient looked like.

 

[Cassowary]

Ethics is moot nonsense made to be a topic of Pointless and hypothetical conversation for idealists and pretentious sophisticated people. Who cares about ethics. Life isnt ethical. Some single mother getting cancer and not having money to pay for her chemo is unethical. Life isnt about ethics.

The state of ethics in American healthcare especially, which is so far beyond “ethical code” for any doctor to save by being “ethical”.

Do whatever you feel is right. I feel that billing a rich evil insurance corporation with all too much money that offers no service, so I could feed my family, is right.

 

[deleted480308]

Ethics is moot nonsense made to be a topic of Pointless and hypothetical conversation for idealists and pretentious sophisticated people. Who cares about ethics. Life isnt ethical. Some single mother getting cancer and not having money to pay for her chemo is unethical. Life isnt about ethics.

The state of ethics in American healthcare especially, which is so far beyond “ethical code” for any doctor to save by being “ethical”.

Do whatever you feel is right. I feel that billing a rich evil insurance corporation with all too much money that offers no service, so I could feed my family, is right.

Nothing unethical about not having money for an expensive service

 

[lejeunesage]

Perhaps this is a self-serving arguments meant to rationalize what I'm doing, but I don't think seeing the "healthy" patients is solely about maximizing one's income potential.

If someone doesn't have any medical needs, then they really shouldn't be in inpatient rehab, because that's one of the core admitting criteria.

Of course, in the real world, theoretically admission criteria are not always adhered to.

Still, consider this: have you ever gone to examine a patient you assumed was healthy, and realized from the history, physical, or your review of labs and vitals that they weren't as healthy as they appeared at first glance? How would you have known what you learned if you hadn't done a chart review and seen them that day?

You can think of it as daily medical surveillance. By seeing those patients and reviewing their records, you are performing a valuable medical service, even if you don't end up changing your management that day. And suppose that you don't see a patient you assume to be stable, and they have a complication and decide to sue. Do you think it would be a proper defense to say that you didn't see them because you were trying to minimize the costs to them and to the system?

Personally, I round on my patients 5-7 days a week. The vast majority of them have complex medical issues. I think billing and getting compensated for the daily chart review and face-to-face assessment we do is fair.

 

[j4pac]

Even if there isn’t an acute medical issue to attend to, there is just about always either prevention or education that you can provide.

 

[Gauss]

If you are professionally liable for the care of these patients on those days, then you should be charting. If you get called or things go sideways and there is an unexpected or bad outcome, no documentation might be considered deviation from standard of care and negligence which opens you up to malpractice and (more commonly) medical board complaint/investigation. As you see more things over the course of your career, your top priorities will include risk reduction and time management (time = money) while maintaining income. Eventually, time will be more valuable to you than money