[HSF] double negatives
Michael Firstenberg
msfirst at gmail.com
Wed Jul 4 16:56:21 EDT 2007
Ed,
Interestingly, the more and more they pile this crap on us the less I
am worrying about it. Discharge paperwork for CMS - not my problem
that sounds like a hospital administration issue. We have been
fighting a HUGE battle regarding pre-operative antibiotics even
before reporting them became a requirement. Early on, most of our
Anesthesia folk claimed it was not their problem/job - and after
years of fighting - guess what - compliance is now their problem.
Yes, I take the hit in terms of infection rates, but if the patient
is not given the right bug juice on time - their problem. Not quite
sure what the consequences will be, but they are now responsible.
CMS no longer paying for Staph infections or hospital acquired UTIs -
hey, again that sounds like some administrator is going to have to
figure that one out. Me? I am salaried and I treat whatever walks
thru the door. Not my fault if we cant collect. Like every other
government mandate - just creates more headaches all around. We, the
surgeons have just said NO to filling out some more of this outcome/
compliance paperwork - if the hospital thinks it is important, then
they need to hire someone to collect it. Not easy and it does
require a group effort, but we are finally saying "it is not my
job". My job? Get my patient off pump and home.
michael
On Jul 4, 2007, at 12:35 PM, Edward Bender wrote:
> Mike:
> I share your pain. However, I think this is a prelude for even
> more to come. I am convinced that we will have a democratic
> president and democratic congress in the US in 2009. I also think
> that the Clintons and Barak Obama have broken the code when it
> comes to universal health care (thanks to Hiliary's missteps in the
> 1990's). The key to putting through universal healthcare (ie, a
> medicare program for the entire population), is to go through the
> insurance companies. Existing companies will administer the plans,
> there will be set stoplosses funded by the federal and state
> governments to protect the insurance companies, and that funding
> will be through increased taxation on the wealthiest of the
> population. The initial setup for these programs will be via a
> RETROACTIVE tax increase (styled after the one in 1992 when Bill
> Clinton was elected). In this way, this potentially risky
> insurance sector will have guaranteed profits, and will be
> alleviated of a majority of financial risk.
> It has always seemed to me that it did not matter what party was in
> power regarding physician income/lifestyle. It seems that when
> republicans were in power, money flowed away from entitlement
> programs (ie, less reimbursement) but taxes decreased. When
> democrats were in power, money flowed into entitlements (ie, more
> reimbursement or decreased rate of decline) but taxes were raised.
> Therefore, overall standard of living was awash (in general). This
> may change in 2009 to 20012. How good or bad remains to be seen.
> If we can be relieved of a lot of this tort negligence, it may be
> worth it, but I'm not holding my breath. Just get ready for more
> regulation. The tendency will be to resist or fight it, but maybe
> we should all re-read the book, 1984, to get a flavor for how
> futile resistance will be.
>
> Signed,
> Big Brother
>
> not really
>
> Ed Bender, MD
>
>
> On Jul 4, 2007, at 10:41 AM, Michael Firstenberg wrote:
>
>> The short answer is that we are easy targets. We keep taking it
>> on the chin
>> and coming back for more. Everyone complains that we make too
>> much money
>> and yet (at least in the US and probably everywhere else) they
>> want instant
>> access to top doctors, top health care, top everything 24 hrs a
>> day. Here,
>> in the US - July 4th - national holiday, took me an hour to drive
>> to work
>> (usually 15 minutes) to meet with a family about an upcoming
>> operation - at
>> their convenience. Try calling your lawyer today (even if it is a
>> crisis)
>> or your stock broken, insurance agent, real estate agent, plumber,
>> etc.
>> Sure, you may get ahold of them (at their vacation homes, on the golf
>> course, trout fishing) - but just wait for the bill for that 15
>> minute phone
>> conversation. Besides, they dont even have to pay for their
>> health care -
>> again, people do not appreciate or even understand the value of
>> the services
>> that they require/want. Then, on the other side we work our butts
>> off and a
>> fluke accident happens or something out of the ordinary (so what
>> if the
>> patient is a non-compliant overweight poorly controlled diabetic
>> smoker) and
>> everyone wants to place blame. Now CMS (medicare/Medicaid) is
>> publishing
>> AMI/CHF 30 mortality statistics, patient satisfaction results, and
>> I guess
>> the latest is that patients must sign a form agreeing 2 days in
>> advance to
>> getting discharged - and if they disagree then it goes to a unbiased
>> moderator (hmm - who is going to pay for that???) We take a stand on
>> something and we get marked for abandoning our patients, our
>> hospitals, or
>> oaths. And, yet here on this National Holiday - just try to get
>> ahold of an
>> administrator or supervisor if you have a problem. I am not
>> complaining,
>> that is the way things are and that is why we chose this field. My
>> patient's families hug and thank me for saving their loved ones in
>> their
>> time of need - that I why I do this. We are expected to be
>> perfect - at
>> times I dont mind that reputation as I strive for it and families
>> at times
>> recognize that is not the case when the see how hard we work and
>> how much we
>> do care. It sure beats the alternative - people expect their
>> lawyers to
>> be...... (fill in the blanks). If people are satisfied in life being
>> mediocre and having other expect that of them and expect to live
>> and die by
>> a timecard/hourly rate/billable hours then fine. I am looking to
>> buy a new
>> condo to live and the developer "does not negotiate on price" -
>> fine, when
>> he comes in the hospital and needs "my" services then he can pay
>> full price
>> also. OK, enough rambling.....We are not the bad guys in all of
>> this - the
>> system is - yes there are bad, greedy, apathetic doctors (and
>> probably a few
>> that can be classified as "terrorists") - but in the end, are we
>> not all
>> passionate zealots - if not martyrs for our causes?
>>
>>
>> -michael
>>
>>
>> On 7/4/07, Tea Acuff <tacuff at swbell.net> wrote:
>>>
>>> Speaking of double negatives has anyone noted the sense of
>>> incredulity in
>>> the reports on the Muslim doctors in the UK who played a part in the
>>> terrorist attacks. This is from the same media sources that
>>> usually talk of
>>> our (as physicians) failures, negligence, and greed. The concept
>>> of killing
>>> healers is really a contradiction deep in the psyche of the West
>>> despite its
>>> mouth piece preference for jaded pseudo sophistication.
>>>
>>> tea
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