FMLA or STD paperwork when inpatient

[TerraceHouse]

In training, I don't think I ever saw an attending fill these out if inpatient setting. I've gotten sent a few FMLA or STD paperwork my way and wondering why the hospital paperwork that specifies dates of hospitalization doesn't suffice. The FMLA/STD requests are not for covering the duration of a PHP program, for example, but rather ambiguous requests for FMLA/STD asking details that I cannot answer as an inpatient doc such as how many appts I will continue to have with pt, how long I suspect that patient will have this condition for, etc.

Asking the hive, what do you guys do?

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[Sushirolls]

That's because the residents filled them out...

IP docs should fill out the FMLA for the dates of hospitalization and maybe even a few extra days post discharge to facilitate getting refills, etc.

As for the rest, put down "no idea" "up to treating outpatient physician" or whatever. But at least cover those days they were in the hospital.

An inpatient unit I used to work on years ago had stellar SW, and they would pre-fill out to those specifications, then be like, "yo, Sushi, sign" and I would sign.

 

[whopper]

On FMLA forms it'll say employers are supposed to list the employee's responsibilities, and then the physician is supposed to state which of those responsibilities the patient can't perform due to the health problem.

Not once, repeat not once, again, not once, one more time-not once did an employer ever give me the list unless I told the patient I was refusing to do the FMLA papers until I got the list.

Add the frustration, several of these patients had their HR depts give them them the forms. If it's your job to study FMLA as much as you're required in an HR graduate course and they teach this stuff, why don't you give the doc the list of employee responsibilities.

 

[Sushirolls]

@whopper This is inpatient. Patients are inpatient. They are doing 0 duties while inpatient, and if the patient is discharged, then they can do all duties. *unless patient/out patient provider want to manage differently. It's like the easiest of the FMLA to ever fill out.
"patient hospitalized"
"Patient hospitalized"
put down the dates
boom, done.

 

[whopper]

Inpatient--oh....I see now.

 

[Bartelby]

I agree with Sushi. The inpatient psychiatrist should fill this out at least for the hospitalization itself. The next provider can take over for any additional leave from there. If you deem it medically necessary for the person to be in a locked inpatient unit (and you are not going to let them leave for part of the day to go to work, which of course never happens) then it seems like a slam dunk that they qualify for leave.

 

[TerraceHouse]

Got it, I have no problem specifying for the dates under my care but often it is 3+ pages asking about functions at work, how much longer I suspect the patient to suffer from said condition, how long will they be able to complete serial 7s, etc.... also are short term disability papers different? Some of them don't say anything about FMLA but rather it's from a company like Sedgwick to fill out short-term disability paperwork.

-Edit-

Also this paperwork is presented often times weeks after discharge

 

[mistafab]

I usually give them leave during hospitalization and up to the post-hospital follow up if that’s reasonable (I.e. 1 wk).

Let the outpatient psych decide if the person is still good, or in a state that if they return they might get fired (smoldering manic).

 

[Ironspy]

I discuss with the patient/family what they think they need and if it sounds reasonable to me I ask them to fill it out and I just review and sign

 

[esob]

I was told that we won't fill this out for inpatient stays and that we must defer that paperwork to the outpatient psychiatrist (not as a legal standard but as something put into place by the administration, who decided it was not an appropriate use of our time). Hence, I, too, am curious about what the policy is at other institutions for inpatient stays that require FMLA paperwork.

 

[PsyDr]

. also are short term disability papers different? Some of them don't say anything about FMLA but rather it's from a company like Sedgwick to fill out short-term disability paperwork.

FMLA- is unpaid protection from getting fired because you are gone from work for a medical purpose. This goes to the company.

STD- is a private contract between the individual and a third party company. It has almost nothing to do with the employer. If the person meets the terms of the policy, it pays. The terms of the policy decide what counts and what does not.

You should read the AMA's book on return to work.

 

[annoyedpsychiatrist]

filling out fmla doesnt bother me at all and im very flexible with what the patient needs for this. Ultimately they dont get paid for it, its just a way for them to keep their job. ANd people do worse without employment, so it only benefits them ensuring they have a way to support themself

 

[comp1]

Sure, I would fill them out very generically while the person was inpatient for the duration of the hospitalization. I would only touch anything related to post discharge if I had confirmed the person was doing a partial or some other step down program. If so, it would be a very brief period of time <1 week to allow the program to take over that paperwork. If they aren't doing an intensive outpatient program, they should be returning to work ASAP.

 

[HemeOncHopeful19]

filling out fmla doesnt bother me at all and im very flexible with what the patient needs for this. Ultimately they dont get paid for it, its just a way for them to keep their job. ANd people do worse without employment, so it only benefits them ensuring they have a way to support themself

That isn’t true in many states these days there is paid FMLA (although that may not apply to you)

I know this is a separate issue should not need a physician’s autograph to verify that a patient was hospitalized.

 

[VA Hopeful Dr]

I was told that we won't fill this out for inpatient stays and that we must defer that paperwork to the outpatient psychiatrist (not as a legal standard but as something put into place by the administration, who decided it was not an appropriate use of our time). Hence, I, too, am curious about what the policy is at other institutions for inpatient stays that require FMLA paperwork.

As an outpatient doctor, that policy would infuriate me.

I'm family medicine so don't usually get the psychiatric hospital follow-up appointments but I do for everything else.

The next time an orthopedic surgeon refuses to fill out FMLA on a joint they replaced and tells the patient that I need to do it might very well be the day I slash that surgeon's tires.

 

[aim-agm]

As an outpatient doctor, that policy would infuriate me.

I'm family medicine so don't usually get the psychiatric hospital follow-up appointments but I do for everything else.

The next time an orthopedic surgeon refuses to fill out FMLA on a joint they replaced and tells the patient that I need to do it might very well be the day I slash that surgeon's tires.

You should leave a completed FMLA form by the surgeon's car: "Unable to work secondary to inability to limit the degree to which they infuriate others to below 'slashing tires' levels."

 

[annoyedpsychiatrist]

That isn’t true in many states these days there is paid FMLA (although that may not apply to you)

I know this is a separate issue should not need a physician’s autograph to verify that a patient was hospitalized.

yea for the states i worked in t was always unpaid, but if it was paid then I agree that is a big difference

ultimately i want my people to work

 

[clausewitz2]

I was told that we won't fill this out for inpatient stays and that we must defer that paperwork to the outpatient psychiatrist (not as a legal standard but as something put into place by the administration, who decided it was not an appropriate use of our time). Hence, I, too, am curious about what the policy is at other institutions for inpatient stays that require FMLA paperwork.

As an outpatient doctor, that policy would infuriate me.

I'm family medicine so don't usually get the psychiatric hospital follow-up appointments but I do for everything else.

The next time an orthopedic surgeon refuses to fill out FMLA on a joint they replaced and tells the patient that I need to do it might very well be the day I slash that surgeon's tires.

It's especially fun when you find out they were hospitalized from them when they show up to the appointment with the paperwork and are iff-y on the precise dates or discharge diagnosis. That is a deeply obnoxious policy.

 

[TerraceHouse]

This has all been so helpful and I'm currently reading the AMA's book on return to work. Speaking of which... I was also just asked by a pt discharged a month ago to fill out a "fit to work" document so they can go back to teaching. This paperwork also asked questions that I don't know if I am, as the inpatient doc, the right person to fill out as it pertained to how closely I'll be working w/ the pt to monitor that they be fit to return to work. I have no idea since I'm not continuing to care for pt. The pt's OP provider is a PA who keeps directing the pt back to the hospital to get all this paperwork completed.

 

[comp1]

Call the PA to discuss. You don't have a relationship with this patient any more...

 

[Bartelby]

Fitness for duty after discharge is a different issue. That is for the outpatient provider or (more likely) a forensic evaluator. The employer may be requesting this for reasons that are not clear to you and a real fitness for duty evaluation involves review of all relevant records.

 

[FlowRate]

Got it, I have no problem specifying for the dates under my care but often it is 3+ pages asking about functions at work, how much longer I suspect the patient to suffer from said condition, how long will they be able to complete serial 7s, etc.... also are short term disability papers different? Some of them don't say anything about FMLA but rather it's from a company like Sedgwick to fill out short-term disability paperwork.

-Edit-

Also this paperwork is presented often times weeks after discharge

I hate these Sedgwick forms. They are asking us to do functional capacity evaluations. They also badger me like weekly for one of my patients. I would similarly love to hear how others address these (far more obnoxious and detailed than FMLA) forms/requests.

Our local occ med consultant guy recommended not filling them out but then it feels like you're screwing the pt unless the company does have an IME they can refer to when the outpatient doc refuses. Nor sure if they do that for STD.

 

[VA Hopeful Dr]

I hate these Sedgwick forms. They are asking us to do functional capacity evaluations. They also badger me like weekly for one of my patients. I would similarly love to hear how others address these (far more obnoxious and detailed than FMLA) forms/requests.

Our local occ med consultant guy recommended not filling them out but then it feels like you're screwing the pt unless the company does have an IME they can refer to when the outpatient doc refuses. Nor sure if they do that for STD.

Refer to occupational health. They're the ones who specialize in this.

 

[Sushirolls]

Refer to occupational health. They're the ones who specialize in this.

Seems so obvious!
Man, I need to start doing that. I've told patients how their employer needs to facilitate this referral to Occ Med in house or out of house themselves. But now, I think I'll start providing a local list of the Occ Med folks.