Posted on 01/24/2015 1:27:06 PM PST by LucyT
MRSA is in the environment, it is not coming from hospitals anymore. Patients are bringing it into the hospital.
Nope, it is going to make physicians refuse to see these patients. They will overwhelm the ERs. I agree with lowering government cost, but I want to be paid a fair wage. I worked in a clinic where the doc got $30 from Medicare to see a patients. That is not sustainable.
More govt involvement in healthcare is not the answer. It’s causing more problems than it will ever solve. Of course, it’s good for paperpushers and administrative types like yourself.
My wife was in the hospital a few times (childbirth and appendix). I would tend to bring her burgers and milkshakes rather than have her deal with hospital food.
I work in an inner city hospital and can tell you that these rules are not going to improve care, they are going to close hospitals. Our nurses are non-unionized, so I don’t know why you think that is such an issue, but it isn’t where I am.
No complication is entirely preventable, no bad outcome can be avoided every time. Sometimes patients get better, sometimes they don’t. Because Medicare won’t pay for catheter-caused urinary tract infections, hospitals now don’t use catheters nearly as much. There is not enough staff to be ready with bedpans every second because of other cuts in reimbursements and forced indigent care. So bedsore rates go up due to pts being left wet longer than they should. All of these mandates have unintended (?) consequences that are destroying the greatest health-care system in the world. (which got that way BEFORE government became so intrusive in case anybody noticed).
Medicare recently stopped paying if a patient is re-admitted within a certain number of days. Patients with COPD and CHF, for example, ‘bounce back’ all the time. They clear after a day or two of intense (very expensive) treatment and go home. They then relapse, often after a few good days, whether they are compliant with meds or not, because that is the nature of the disease (the ‘C’ in both cases stands for CHRONIC). If they are re-admitted, Medicare WON’T pay, but if you keep them longer Medicare also won’t pay because ‘length of stay’ is limited. These patients often require ICU and more (again expensive) treatments. Our hospital has a large population of non-compliant patients so will be losing money hand over fist as this policy expands. Given we also have a large indigent and medicaid population, it is only a matter of time before the cuts shut us down. We are already cutting physician hours in the ER and switching to nurse practitioners, because ‘we don’t have the numbers’. What that really means is ‘we don’t have the money.’
All these mandates and hoops and denials of payment come down to one thing. The government forces hospitals and physicians to provide medical care, and the government doesn’t want to pay for it. Hospital administrators have been playing this game and managing to stay open and even maintain a profit margin so far, because until now, most of this has affected physician reimbursement more than hospitals. Now that the hospitals themselves are being denied, when they are already strained, I think the game is over.
No hospital can sustain itself under these conditions. Costs of hiring enough people to try to prevent the unpreventable and not being paid for taking care of patients with major medical issues that by their nature make patients sick enough to be hospitalized often, coupled with increased indigent and Medicaid patients on whose care hospitals and doctors don’t even break even are going to close any hospital that is teetering now. Loss of Medicare as ‘punishment’ is going to push several over the edge.
Hospitals are businesses, and they have to make a profit to survive. They are going to close because of this government witholding of payment for services, especially as more and more people become dependent on government healthcare. Inner city hospitals who serve sicker, poorer, less compliant patients will go first, and there will be a great cry of ‘discrimination’ and ‘corporate greed’ and ‘racism’ when it happens.
Likely the government will start providing free transportation to the suburban hospitals which will then be overwhelmed and underpaid as their reimbursements drop, so they too will close.
I have no idea what people will do then, I suppose they can show up at their local Obamacare or IRS office with their MI or stroke or appendicitis.
O2
Some hospitals seem to avoid infections much better than do others.
thus, you have old people climibing out of bed by themselves and falling.
And you have patients climbing out of bed by themselves because the staff won't respond to a call button.
You come across as having a casual attitude about patient safety. Do you have a high percentage of 'practically unavoidable' infections on your shift?
One of the local hospitals has a terrible reputation for infections for post-op surgery. I won't name hospital names, but it wasn't really terribly shocking when a couple of nurses turned up with Ebola there.
Well, I was hoping the packers would win. I don’t want to play the Hawks.
We are not going to solve the worlds problems here. But thanks for a civilized discussion. Kind of rare these days.
Quality statistics are what they are...a measure of whatever you’re looking at, regardless of whether what you’re looking at has any relevance to patient care or outcomes.
If you think that what the government says we have to ‘measure’ has a basis in medical science, think again. The government picks and chooses things based on whether they think hospitals can be held accountable for shortfalls to cut payments...like infections..which they say are ‘100% preventable’ which is nonsense.
I am amazed that there are people supposedly on the same side of the fence politically as me, who say that they trust the same government to be looking out for their best interests in health care while they rail about government lying about countless other issues and look at a multitude of evidence where the government acts in a manner of self-preservation. This health care stuff is just an act, designed to limit government costs...NONE of it improves patient care.
what about those mooslies that don’t believe in washing their hands. Have they looked to see how many were working in those hospitals?
Obamacare is being used to eliminate treatment of Medicare patients. A lot of money is going to be saved on Medicare. In a couple of years, perhaps sooner there will be no hospitals that will take Medicare patients and few or no doctors. I saw this coming when I first read that hospitals would lose Medicare reimbursements if patients are readmitted after a procedure.
I respectfully disagree.
But, every time I brought quality control to an operation I heard about every one in a thousand exception, and how the statistics did not represent “THEIR” workplace.
As conservatives, we want the government to control expenses and cut down on incompetence. But when they try to DI it you cry.
How would you establish controls to make sure the Medicare taxes you have been paying for fifty years are spent on improved patient outcomes.
Hubby recently had surgery and spent 3 days in the hospital. My granddaughter and I went down to the cafeteria to have breakfast. I saw the biscuits and gravy and ordered it. When the gal handed it to me she said the gravy was made with vegetarian sausage. I handed it back to her and said....there’s no such thing as vegetarian sausage. Lol. I had a muffin instead.
You can respectfully disagree, I got no argument there.
But the Government is NOT instituting these ‘quality control’ measures based on any science at all. Nothing they have demanded to ‘meet standards; is means tested or validated. It is purely economical.
Go research the most recent recommended ‘standards’ re: blood glucose control in peri-op CABG patients, published less than a few months ago...which they promptly and recently threw out as they realized that more patients were being harmed by hospitals trying to comply with their ‘standards’ so the standard was ditched in short order...before any stats were evident or published.
How can you trust an entity that has a HUGE financial interest in the process setting the standards that will determine the payment for that service? Seriously?
So you are advocating letting hospitals bill whatever they want without any measurement of success?
Because if you are not applying standards—most of which have been around for a long time—then you have no idea who is doing anything correctly.
As conservatives, how do you suggest the government pay their bills through medicare?
Can you please explain some ways that we can do this, today, across a broad spectrum of patients that is growing daily as people hit 62 by the millions.
As an ER nurse and nursing educator, I could not possibly find your comments more ill-informed. Clearly you know absolutely nothing about which you write. Allow me to educate you.
Speaking from my position of expertise, I applaud the withholding of compensation for patient recidivism (that means be re-admitted within 72 hours after being discharged from a hospital for the same diagnosis). There is no excuse for sloppy treatment or procedure- ever.
Meanwhile, nurse leaders, educators, and staff will continue to push for the improvement of patient safety and healthcare delivery- just as we have been for the last 50 years through research, education, political action, and literature.
I work at a hospital that has spent millions upon millions of dollars improving everything from informatics to medication preparation to food service to even how staff communicate with each other. As a result, our hospital's annual error rate has been reduced from 23 to 3. And that's the total from all units.
And the taxpayer did NOT pay for that. We, a privately-funded hospital, did it on our own with hospital staff and administration working together for 5 years to make the improvements. And that, sir, is not reflective of the intellectually-lazy, sloppy, bad, dirty, incompetent "civil servant" attitude that you have ascribed to us.
So in conclusion, and as a response to your ill-considered and uninformed condemnation of my colleagues and myself, I cordially invite you (and anyone else here who thinks was you do) to kiss my ass. If you think you can do my job better than I can, step right on up.
Well as an ER nurse, I find your response to prove my point. Why do you think your hospital went on the quality kick? Do you think it was to “improve” the error rate? Or do you think it was a reimbursement rate.
And shame on your for bragging about improving your error rate from 23% to 3%. Your administrators should be in jail for allowing that to happen.
And how did you manage to measure that. Other posters are telling me you cannot manage “widgets.”
Again, I am simply amused by the nurses who think their performance cannot be measured objectively. And, as the government is the largest provider of insurance reimbursements, you cannot stand by the sidelines and pat yourself on the back for your improvements.
All true conservatives would like the government out of the insurance business. I think on that we can agree.
But that is not about to happen. So I have to laugh when the people posting on this site get all up in arms about objective measures being instituted. Are they perfect? No. But by your own admission, the impending implementation of these metrics caused your organization to improve on your quality from hurting 23% of your customers to only 3%.
Can you think of another business that could survive with a 23% error rate?
I know we should “strive for perfection” and certainly we expect that from our medical providers. I have my eyes wide open to the repeat offenders and the people who simply have no regard for their own care. I understand that.
My profession is assisting companies find their areas of opportunity. The first step of that is coming up with metrics where there were none. It is clear you cannot do what I do, or your starting number would not be 23%.
I applaud your organization for fixing the problems. I am sincere in that. There are too many places, all over the country who give lip service to quality—clearly yours is not one of them.
But, someone like me probably came in and said, why are your reimbursements the way they are? Someone came in and said, “In the near future your reimbursements are going to be measured against ‘these’ criteria.
Without seeing you, I am not sure I would find pleasure in kissing your ass. Its a preference thing. If you are a male nurse, and you ass is covered in hair...that would be distasteful for me. :-}
After reading your response, and considering the state of your hospital five years ago, I think we are in complete agreement.
As a nurse, please tell me, were you in complete agreement with ALL of the changes that were put in place. Were the complaints? Was there resistance? Did they add to staff? Did they add new software to comply with the electronic billing systems? I would be really interested in hearing the story. If you would prefer to send me a PM, I would love to engage in a conversation, not a debate.
A drop in errors to the degree that you cite, is a real success story. I am willing to bet the CFO of your company is dancing in the streets. I am also willing to bet that yours will be a company that ends up buying smaller hospitals where you can benefit from improving their quality.
Yes, I am sort of a bean counter. I do not see patients as widgets. But I know that time is valuable. If you do not have to see the same patient over again in 72 hours that is going to translate into better care, and less stress in the system. And then ends up with a better patient experience. And that makes everyone happy.
Again, aside from the snotty ending, we are talking about the different ends of the same rope. I am talking about the beginning and you the end.
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