Q&A with Dr. Tom
When my dual eligible patients get admitted into the nursing home for permanent placement, the administration is quick to change them over from their special needs plan to traditional Medicare with Medicaid.
When challenged about this they cite the financial advantage to the patient with no reference to the medical benefits of the program.
Sometimes they even dis me in front of the patient as being out to make a buck. I'm losing a lot of revenue when these switches happen and it makes nursing home medicine a losing proposition.
How do I handle this?
Carefully and then forcefully.
Take time to educate the nursing home administration regarding the benefits of special needs plans. Explicitly admit the financial benefits to yourself---and emphasize that those benefits keep you able to take care of your nursing home patients---and referring them patients.
Engage with them. Demonstrate that your presence in the nursing home is of significant value to the organization and the nursing staff.
Ask to be present when any discussion about enrollment changes occur.
Give it a little time to build your credibility.
If it keeps happening take a private meeting with the administrator.
Advise them of your concerns, the steps you've taken to address them and the continued concerns.
Tell her in no uncertain terms that if the behavior continues you are not only certain to discourage your patients from using their facilities, but you will be advising your colleagues of their behavior and the threat it poses to to their livelihoods and business models
Put her on notice that you will cease seeing any patients in the facility if it happens again.
Then follow through.
Don't worry about the patient. If they feel strongly enough that they must be in that particular nursing home that they're willing to change doctors, then your bond with them isn't as strong as it needs to be---and certainly not strong enough to provide cost-efficient care at the end-of-life.
Let someone else deal with all the uncompensated care and the increased liability which fee-for-service nursing home care entails.
Better a stable of a small number of collaborative nursing facilities than messing with a whole bunch, who don't respect you.