Can an outpatient wound center, or any outpatient clinic for that matter, be restricticted to only ordering and handling product that the Hospital (inpatient) has a contract with? Keep in mind this wound be for insurance reimbursed products. Hospital would be paying nothing. Thoughts, anyone come across that in the field?
Perhaps they could TRY to by hospital policy, but physicians can order any outpatient NPWT product they choose and this tactic has been ineffective in the past. The patient's insurance may dictate which NPWT product if they have a contract with a particular NPWT company.
If the hospital owns the wcc or clinic, you bet they can dictate what products are used. In this day and age, you are naive not to expect it. Or if the wcc or clInic are part of a GPO, that GPO might hold them to a certain compliance level. If the product is not on contract but provides a better economic picture, you got a chance.
Op here. Thanks for the responses. In this case the product is reimbursed by insurance. The clinic nor the hospital are on the hook for the bill. The patient's insurance would cover the cost. The wound center is being told by a purchaser that because the hospital has a contract with a certain supplier, they can only order from that supplier out of the wound clinic. This seems to me to take away patient choice, and put an unfair restriction on the drs in clinic. Additional thoughts?
If you are talking about a "buy and bill" product like SNAP, then you are correct. If you are talking about NPWT like VAV (not the disposable, but the DME), then you are wrong. KCI is a DME provider. No hospital can dictate which DME a patient or doctor chooses to provide NPWT. It's illegal. Hospital wound centers don't understand this, so explain it to them without threatening them.
The wound center is being told by the purchaser that they cannot order from another provider. Purchaser has gone as far as saying they could lose their job if they do. Purchaser is misinterpreting a GPO compliance rule and applying it to something the hospital doesn't actually pay for, thus limiting the clinics choice in the process. Tough situation..
The hospital doesn't understand that it is against the law. The hospital can't tell a patient what DME or DME product the patient needs to use. What happens when the patient stops going to the wound center? The patient does not stop using the NPWT. This is against the law. Why don't wound centers understand this? It's a quid pro quo and is illegal. If the hospital gets better pricing (saving money) on NPWT on the inpatient side for influencing decisions in the wound center (thereby making the NPWT company more money), it is ILLEGAL. My God. Does anybody understand this?
In addition, the contract for DME NPWT is between the patient and his/her insurance company? I wonder how the insurance companies feel that an inpatient facility is illegally dictating outpatient DME product use in the home for which the insurance companies are being billed? This is why healthcare is going down the drain. Are they stupid, are they criminals, or both?
So what can one do about this? Purchaser is telling WC to only order one product. WC is afraid for their jobs as purchaser has told them it's against hospital policy if they were to try. WC has asked i not bring it up again for now as purchaser was upset i was questioning "policy". Any thoughts?
I would bring it up that we are a provider, and not a vendor. Don't accuse anyone of anything, but just say that it is confusing and could put the hospital at risk for extending its reach outside of its domain. It could be perceived as a quid pro quo. Let them know that the hospital does not purchase anything for outpatient DME, the patient's insurance does. And explain that influencing this could cause a conflict with the patient and his/her insurance.
I would bring up that "it is a compliance issue" and that "I understand it is confusing." That way, you are not saying they are doing this on purpose. But, it absolutely is a compliance issue. It is a quid pro quo where the hospital is stepping outside it's reach to get the company business on the outpatient side in conjunction with the inpatient agreement. It is against the law. But say it nicer than that.
LMAO right now, as KCI would tell their accounts this same thing all the time!! "You cant use XYZ in your clinic - we have a contract with the hospital." Then go run to MM to stir the pot. Now youre crying about it? Perfect.
Kci rep is driving this. KCI probably has a contract with the hospital driven by usage. He or she has a good relationship with purchasing. Numbers are down so now the are trying to make it up on the post acute side. There is no way they can dictate what you use in the wound center or what the patient can use upon discharge. If you want further confirmation just call the FDA U.S. Food and Drug Administration 10903 New Hampshire Avenue Silver Spring, MD 20993 1-888-INFO-FDA (1-888-463-6332)
