Is starting an unnecessary IV fraud?

Halothane said:
Why?
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If im not mistaken, sometimes nausea and vomiting could be the only symptom of myocardial infarction. Especially in older populations where there may be little to no pain at all
 
Halothane said:
Cardiac problems can present with nausea?

Oh my. I guess everyone who is nauseous does need an EKG then.....

While we are at it I suppose we better CT every headache, spinal tap every stiff neck, and culture every cough.

And just to be safe, let's give everyone oxygen and use c-spine precautions for all trauma.
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That's a pretty poor outlook to have as a healthcare provider.

And yes, N/V can be an anginal equivalent.
 
ffemt8978 said:
Don't put too much faith in the training levels listed in our members' profiles. They aren't always updated, accurate, and sometimes people choose a student level because they believe they are always learning in this field.
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Well its true Were all always learning in this field, I am an actual student in a paramedic program.

But in this field as any field, You are always the student. Once you feel as if you are a master, and cannot achieve any new knowledge its time to leave the field.
 
IV goes in when I need to give an IV med or reasonably think I will need to give one / pt is at risk of deteriorating.

12 lead ECGs for nausea and vomiting?

If I did a 12 lead ecg on an otherwise healthy 20 y.o F with N&V I would get a big "please explain".

The time you spend sitting on scene trying multiple IVs just so the hospital doesn't have to do it is increasing time between the patient and hospital.
 
teedubbyaw said:
That's a pretty poor outlook to have as a healthcare provider.

And yes, N/V can be an anginal equivalent.
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I do not think he was arguing that N/V can be an anginal equivalent but rather that every N/V complaint should get a 12 lead. A 60 y/o Diabetic female smoker complaing of N/V? Of course.

Just as a new LBBB can be a STEMI equivalent not every patient is getting an emergent cath.
 
And procedure a provider does knowingly unnecessary I would consider fraud
 
Chase said:
I do not think he was arguing that N/V can be an anginal equivalent but rather that every N/V complaint should get a 12 lead. A 60 y/o Diabetic female smoker complaing of N/V? Of course.

Just as a new LBBB can be a STEMI equivalent not every patient is getting an emergent cath.
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It's is precisely because nausea/vomiting can be an anginal equivelent is the reason why most, but not all N/V Pt.s need a 12-lead.

If I give you morphine for pain management and you feel nauseated afterward, a 12-lead is of no benefit.
 
We keep drifting back and forth here, but I think we should focus a little because the OP's original question was an important one.

  • Yes, starting an IV when not indicated IS fraud, if you bill for it. It is the very definition of fraud, in fact. That isn't my opinion, that is how CMS and the insurance companies and the courts see it. People - usually physicians but not always - are sued and fined and have their CMS "privileges" revoked for medically unnecessary procedures all the time.

  • Starting an IV (or performing any other procedure) without a true indication, even if it doesn't rise to the legal definition of fraud (perhaps because you don't bill for it), is still wrong any way you look at it. You will not find a professional association that endorses exposing patients to the discomfort and risk of unnecessary procedures for "practice", nor would you likely be able to argue that you were following the standard of care or acting in the patient's best interest if some serious complication were to arise from a procedure that you performed just because you hadn't done one in a while. Not to mention the fact that it requires you to falsify the medical record, that is unless you actually document "IV started just because I need the practice".

  • As far as what constitutes whether or not an IV or other procedure is indicated, well that is obviously up for debate. I think it is silly to do something in the field just because "they are gonna do it in the ED". I disagree that nausea is an indicator for an EKG for instance, but obviously there are those that disagree with me. I don't think most patients should be back boarded or have a NRB placed, but there are those who disagree with me. So that's the real question here, I think.
 
I think this whole discussion may be moot. With the Affordable Health Care Act in affect, EMS may see big changes, one being accountability. For EMS companies, I see a big change looming and every penny spent will need paperwork. By 2018 I foresee a whole new practice in the US EMS system. In other words, you drop an IV, better have a reason. Just my prediction/opinion.
 
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Halothane said:
We keep drifting back and forth here, but I think we should focus a little because the OP's original question was an important one.

  • Yes, starting an IV when not indicated IS fraud, if you bill for it. It is the very definition of fraud, in fact. That isn't my opinion, that is how CMS and the insurance companies and the courts see it. People - usually physicians but not always - are sued and fined and have their CMS "privileges" revoked for medically unnecessary procedures all the time.

  • Starting an IV (or performing any other procedure) without a true indication, even if it doesn't rise to the legal definition of fraud (perhaps because you don't bill for it), is still wrong any way you look at it. You will not find a professional association that endorses exposing patients to the discomfort and risk of unnecessary procedures for "practice", nor would you likely be able to argue that you were following the standard of care or acting in the patient's best interest if some serious complication were to arise from a procedure that you performed just because you hadn't done one in a while. Not to mention the fact that it requires you to falsify the medical record, that is unless you actually document "IV started just because I need the practice".

  • As far as what constitutes whether or not an IV or other procedure is indicated, well that is obviously up for debate. I think it is silly to do something in the field just because "they are gonna do it in the ED". I disagree that nausea is an indicator for an EKG for instance, but obviously there are those that disagree with me. I don't think most patients should be back boarded or have a NRB placed, but there are those who disagree with me. So that's the real question here, I think.
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It goes back to my point that I stated probably a few pages back now, Patient assessment is the most important factor in any healthcare profession. A 20 yr old female who is currently experiencing N/V most likely does not need an 12 lead ECG, if the N/V is motion sickness related Zofran is a moot point as its not indicated for motion sickness. Depending on the length of the nausea vomiting and a good HPI can warrant an IV especially if they are dehydrated if they are two sheets to the wind. It might be best to let them puke that crap out and babysit the airway.

Sandog said:
I think this whole discussion may be moot. With the Affordable Health Care Act in affect, EMS may see big changes, one being accountability. For EMS companies, I see a big change looming and every penny spent will need paperwork. By 2018 I foresee a whole new practice in the US EMS system. In other words, you drop an IV, better have a reason. Just my prediction/opinion.
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In todays system, if you drop an IV you better have a reason. If I went and sunk a line into a patient with a rash. what was the purpose of my IV? Especially if they go to the ED and they give them a topical ointment and send them packing?
 
Halothane said:
Such as? I've heard very little about how the ACA might affect EMS.
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One thing that comes to mind is the sudden explosion in "Mobile Inter-graded Health Care" by EMS in the past 12 months, along with how this may effect ACO's.

Its still early to say, but that is one thing I am following.
 
This from the ACA. This could be a good thing in some ways and bad in others. From the driving routes we take to hospital x, to the non-emergent patients we routinely transport. Affordable health care will change EMS as we know it. Again just my prognostication.

Emergency/Trauma Regionalization – Law directs the Secretary of HHS, acting through the Assistant Secretary for Preparedness and Response (ASPR), to award at least four multi-year contracts or competitive grants to support pilot projects that design, implement and evaluate innovative models of regionalized, comprehensive and accountable emergency care and trauma systems.

Trauma Centers – Law requires the Secretary of HHS to establish three programs to award grants to qualified public and Indian trauma centers that would assist in defraying substantial uncompensated care costs; further the core missions of trauma centers (including addressing costs associated with patient stabilization/transfer, trauma education/outreach, coordination with local/regional trauma systems, essential personnel and other fixed costs, and expenses associated with employee/non-employee physician services); and provide emergency financial relief to ensure the continued/future availability of trauma services.

Emergency Medicine Research – Law requires Secretary of HHS to support federal programs administered by NIH, AHRQ, HRSA, CDC and other agencies involved in improving the emergency care system to expand and accelerate research in emergency medical care systems and emergency medicine, including: (1) the basic science of emergency medicine; (2) the model of service delivery and the components of such models that contribute to enhanced patient health outcomes; (3) the translation of basic scientific research into improved practice; and (4) the development of timely and efficient delivery of health services. In addition, the Secretary of HHS is required to support research to determine the estimated economic impact of, and savings that result from, the implementation of coordinated emergency care services.
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Sandog said:
This from the ACA. This could be a good thing in some ways and bad in others. From the driving routes we take to hospital x, to the non-emergent patients we routinely transport. Affordable health care will change EMS as we know it. Again just my prognostication.
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all that stuff and more is probably enough for it to justify its own thread. I think there are a lot changes coming down the pipeline. Looking forward to it.
 
Yes, sorry for hijacking your thread...
 
ExpatMedic0 said:
all that stuff and more is probably enough for it to justify its own thread. I think there are a lot changes coming down the pipeline. Looking forward to it.
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Quite Possibly if your ambitious start the thread I would be looking forward to hear how this going to work and elaborate a little bit better
 
unleashedfury said:
Quite Possibly if your ambitious start the thread I would be looking forward to hear how this going to work and elaborate a little bit better
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Sandog should do the honors lol. I have info to add on it also
 
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