Wound care

[Iamnew2]

Hey all, I would like some thoughts on the following situation. I'm a med director of an inpatient acute rehab. I do administrative duties and have clinical duties and see the vast majority of patients as well except when census is too high and then I have another PM&R doc help me out. anyhow, we have a PM&R doctor (aside from the other PM&R doc who helps me out as needed) who comes about once a week and takes care of wounds. This person is pretty old school, and this person's notes are either non-existent or come in days-weeks later if at all. I'm new in the position and I'm trying to get everything in a smooth and efficient process. To my horror I recently found out with the nurse manager that this other doctor despite the fact that they are consulted on only a handful of patients exclusively for wound care, sees all the wound patients (some patients have specific orders from surgeons who don't want someone else touching the wounds except as per their orders and I'm ok with that) AND to my horror this other doctor writes a consult note - as if for the general inpatient care and then notes the wounds as well. I don't know why they are doing this, it doesn't make sense, they are not consulted for inpatient rehab, and this person essentially copies and pastes either my notes or the other PM&R doctor's note and I think bills as if he's doing the overall general consult for inpatient rehab. Obviously this not only will create double billing and will be a raise flag for Medicare but also this is unacceptable. I don't want to rock the boat too much per se but thinking of perhaps asking the hospital to have someone else do wound care. Apparently the staff is also unhappy with this person since they don't communicate with others and no one really knows what they are doing.
Thoughts? How do you all have wounds treated for inpatients? I know of a few companies that do wounds - Healogics, Vohra but I am not sure if they do inpatient or just SNF?
Any assistance would be appreciated. Thanks!

---

Members don't see this ad.

 

[timisdaman]

Talk to him first? You are the director.

 

[RangerBob]

We have a wound care Rn that comes in about 3x per week.

It is fraud for that doc to see patients he's not consulted on, plain and simple. It also adds liability for you, as the attending.

Talk to him. He's the consultant. If he's not providing the quality of services you want, don't consult him. It's that simple. If he keeps seeing patients anyway, then report him to Med Exec, or even Medicare--they pay a whistleblower bonus proportional to their inappropriate charges.

 

[Iamnew2]

We have a wound care Rn that comes in about 3x per week.

It is fraud for that doc to see patients he's not consulted on, plain and simple. It also adds liability for you, as the attending.

Talk to him. He's the consultant. If he's not providing the quality of services you want, don't consult him. It's that simple. If he keeps seeing patients anyway, then report him to Med Exec, or even Medicare--they pay a whistleblower bonus proportional to their inappropriate charges.

Yeah I know that's what is hounding me to a large extent. That he is seeing patients that he is NOT consulted on for one (the nurse manager is like he sees everyone!), but then again I have only been here recently so I am trying to make changes slowly. I also only found this out a few days ago.
Too it concerns me that he would bill like I said for a consult note, as if he's managing the input rehab when he's not, and he's only doing the wound care. To add insult to injury, he copies and pastes the info from it seems other doctors note (prob mine, medicine, the other rehab doc, etc) which is ridiculous, and they are likely super outdated as he doesn't write notes timely if ever. I plan on talking to the CEO and have already brought up the topic in a very polite fashion that this is not working and the CEO seems amenable to chatting further.

Does your nurse though not have a supervising physician? How does he/she bill for the wound care?

 

[RangerBob]

Yeah I know that's what is hounding me to a large extent. That he is seeing patients that he is NOT consulted on for one (the nurse manager is like he sees everyone!), but then again I have only been here recently so I am trying to make changes slowly. I also only found this out a few days ago.
Too it concerns me that he would bill like I said for a consult note, as if he's managing the input rehab when he's not, and he's only doing the wound care. To add insult to injury, he copies and pastes the info from it seems other doctors note (prob mine, medicine, the other rehab doc, etc) which is ridiculous, and they are likely super outdated as he doesn't write notes timely if ever. I plan on talking to the CEO and have already brought up the topic in a very polite fashion that this is not working and the CEO seems amenable to chatting further.

Does your nurse though not have a supervising physician? How does he/she bill for the wound care?

I’m not sure you need to go straight to the CEO. I’d either talk with the doc directly, or you you want a friendly face to get advice from, talk with your program director (if you have one) or whoever is at/just above your level in the “chain of command.” Technically I have no boss, but I’d go first to my program director or CMO (keep in mind my hospital is under 100 beds, so the CMO is very approachable)

I don’t know if our wound RN bills or not. She’s employed by the hospital so it’s honesty not something I’ve ever thought about. Most hospitals I’ve worked at as a fellow/resident had wound RN. I’ve never been anywhere where an MD managed the wound unless it was a post surgical patient, or if the wound needed debridement/excision, in which case it’s gen surg getting involved—who then do their cutting and have the wound RN follow up.

 

[Iamnew2]

I’m not sure you need to go straight to the CEO. I’d either talk with the doc directly, or you you want a friendly face to get advice from, talk with your program director (if you have one) or whoever is at/just above your level in the “chain of command.” Technically I have no boss, but I’d go first to my program director or CMO (keep in mind my hospital is under 100 beds, so the CMO is very approachable)

I don’t know if our wound RN bills or not. She’s employed by the hospital so it’s honesty not something I’ve ever thought about. Most hospitals I’ve worked at as a fellow/resident had wound RN. I’ve never been anywhere where an MD managed the wound unless it was a post surgical patient, or if the wound needed debridement/excision, in which case it’s gen surg getting involved—who then do their cutting and have the wound RN follow up.

Well in our institution the CEO is right above me in terms of chain of command, I report to him in terms of outcomes/issues and I see/talk to him on a daily basis. It's a medium sized hospital so also very approachable. I have no boss in terms of clinical/medical chain of command. We don't have a CMO, essentially the working model is medical director --> reporting to regional CEO --> reporting to overall CEO. I am not sure why we don't have a wound nurse. I am not sure why we have a wound doctor per se. I have asked to chat with CEO and nurse manager and they are all on board with that.