View Poll Results: Which state are you LEAST likely ever to visit or pass through (on the ground)?

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  • Arizona

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  • Florida

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  • Texas

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  • Washington

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Thread: Rep Retirement Lodge 201: A State You Don't Expect

  1. #161
    Veteran leswp1's Avatar
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Quote Originally Posted by Swansong View Post
    Hospitals often hold patients in the ED because they don't have available beds, too. My hospital is almost always full, so it's not unusual for people to have to wait. Fortunately our ED is tiny so we don't get a ton of issues. UMASS Worcester, however, is different. You may wait your entire admission in the ED as a boarder, depending on acuity and availability of required beds. If you're just admitted for observation, this doesn't matter much other than it being more difficult to visit someone in the ED than on a floor. And, obviously, the ED Staff hates it (not to dismiss their opinion - treat your staff well!).


    ACO has changes rather significantly over the past few years. Believe it or not, my hospital recaptures a ton of money from in (I just asked the analyst that manages the patient registries - we're one of the "best" in the state for it). It's a great concept that, most likely, was total garbage in its infancy. The issue is definitely with compliance, which is why they're supposed to follow up (at least) with the CCM and SW. But it still comes down to the patient and/or family at a certain point.
    My patients used to have huge issues with being held in ER or not. If you are held or adm for obs then the billing is different and the patient can get screwed. Yes, sometimes it is about bed availability but we saw a lot of d1cking around to capture the most $$ whether it screwed the pt or not for coverage.

    The concept of ACO is great. It is what used to happen for every patient on the floor when we had patient centered care before we had the drive thru/business model mentality. It should be what every patient gets, not just the ones who might cost more $$.

    The reimbursement structures now are set up to penalize the lack of support planning but they are also set up in a way that doesn't take patient responsibility/situation into account. They will tell you that if you do a good enough job, you should be able to get the patient to comply. Just this past semester one of the sites I visited had a goal of pts A1c being below 10. the patients were eating in shelters, homeless or they were in bedsits with no kitchens, relying on food stamps, which meant they could afford horrible food or eat at shelters. Achieving 10, while not even close to optimal medically was completely stupid for the circumstances. Of course when they didn't meet it they were chastised by administration and the facility lost a boatload of withhold. None of us could believe they did this with a straight face.

    Good Afternoon Lodge!

  2. #162
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Quote Originally Posted by leswp1 View Post
    My patients used to have huge issues with being held in ER or not. If you are held or adm for obs then the billing is different and the patient can get screwed. Yes, sometimes it is about bed availability but we saw a lot of d1cking around to capture the most $$ whether it screwed the pt or not for coverage.
    Yeah, getting the admission type correct is crazy important and it absolutely shouldn't make a **** bit of difference. When I was teaching floor nurses Epic, I got the question "wait, we have to treat them differently if they're observation or inpatient? Or ACO"? Mostly they just did they best they could for the patient and that's all they should have to do. Obviously floor type, acuity and whatnot affect that but patients' admissions status shouldn't matter. But that seems to be a complete loser battle under any of the proposed plans I've seen put forth (ignoring the total pie-in-the-sky "it's all free!!1!1" ideas).

    Quote Originally Posted by leswp1 View Post
    The concept of ACO is great. It is what used to happen for every patient on the floor when we had patient centered care before we had the drive thru/business model mentality. It should be what every patient gets, not just the ones who might cost more $$.

    The reimbursement structures now are set up to penalize the lack of support planning but they are also set up in a way that doesn't take patient responsibility/situation into account. They will tell you that if you do a good enough job, you should be able to get the patient to comply. Just this past semester one of the sites I visited had a goal of pts A1c being below 10. the patients were eating in shelters, homeless or they were in bedsits with no kitchens, relying on food stamps, which meant they could afford horrible food or eat at shelters. Achieving 10, while not even close to optimal medically was completely stupid for the circumstances. Of course when they didn't meet it they were chastised by administration and the facility lost a boatload of withhold. None of us could believe they did this with a straight face.

    Good Afternoon Lodge!
    And here's the problem in a nutshell. It's the same fight teachers are having - if the home life sucks, the kids will fail regardless of the ability of the teacher or any intervention they may try. It seems like we, as a society, are just further separating personal actions from consequences. Diabetic? Have a **** diet? You're going to have problems whether you have a doting physician talking to you every day or not.
    I gotta little bit of smoke and a whole lotta wine...

  3. #163
    Veteran leswp1's Avatar
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Quote Originally Posted by Swansong View Post
    Yeah, getting the admission type correct is crazy important and it absolutely shouldn't make a **** bit of difference. When I was teaching floor nurses Epic, I got the question "wait, we have to treat them differently if they're observation or inpatient? Or ACO"? Mostly they just did they best they could for the patient and that's all they should have to do. Obviously floor type, acuity and whatnot affect that but patients' admissions status shouldn't matter. But that seems to be a complete loser battle under any of the proposed plans I've seen put forth (ignoring the total pie-in-the-sky "it's all free!!1!1" ideas).


    And here's the problem in a nutshell. It's the same fight teachers are having - if the home life sucks, the kids will fail regardless of the ability of the teacher or any intervention they may try. It seems like we, as a society, are just further separating personal actions from consequences. Diabetic? Have a **** diet? You're going to have problems whether you have a doting physician talking to you every day or not.
    In our PHO there was a conscience effort to force actions that would minimize utilization. CHoices were made depending on how it would reflect on the facility's reimbursement not on what would be best for the pt. There was no long term thought. It was all about how to save the $ now and the cost in the future to the pt? Pshaw.This has escalated since medicine switched to the business model. It is not a good fit.

    The separation of personal actions and consequences and the lack acknowledgement of resources. No amount of motivation can overcome lack of resources. The economy may be 'booming' but the social net is shrinking and the divide between those with resources and not is increasing. They try to say if you do everything right then things are attainable but IMHO it is a load of hoo-ey designed to produce failure (which decreases reimbursement). People cost nothing after they are dead. If the person gets too costly and it is difficult for them to get care they die faster. Totally cynical, I know, but the business model has nothing to do with patient outcomes. It has to do with minimizing payout. You set up measures that are impossible. My favorite dichotomy- 'patient satisfaction' with no qualifiers against penalties for doing things that patients think they should have. Give an antibiotic without certain parameters- DING!!! Don't give it and then DING_DING_DING!!! The patient excoriates in the review because they know they need that [x] because they know their body.... either way they manage to keep some of your withhold.
    (there are posts on NP pages I follow where people are asking for hints on how to increase satisfaction numbers when the patient wants something they shouldn't have. And people are responding with all sorts of ways to manipulate data, have staff call, do other stuff. Rarely do you see someone say the obvious- sometimes it is our job to say or do things people don't like. Their being mad or unsatisfied is part of the process)

  4. #164
    C'mon Q! MarkEagleUSA's Avatar
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Good morning to tLodge!
    Quinnipiac Bobcats
    2012-13, 2014-15, 2015-16, 2018-19 ECAC Regular Season Champions
    2013 East Regional Champions, Frozen Four
    2014 East Regional
    2015 West Regional
    2016 ECAC Tournament Champions, East Regional Champions, Frozen Four
    2019 Midwest Regional

  5. #165
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Good Morning, MEUSA!


    Good Morning to the rest of tLodge!

  6. #166
    Short/Round bostonewe's Avatar
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Quiet in here -- are we hunting wabbits?

  7. #167
    Veteran leswp1's Avatar
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Quote Originally Posted by bostonewe View Post
    Quiet in here -- are we hunting wabbits?
    Aw, now I have that in my head.

    Good evening Lodge!

    Productive day- started filling the new garden, went to dinner at dad les, did a load of laundry and prepped for having 2 hungry runners, post long run, for breakfast.

  8. #168
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Evening, Lodge. Went to a nice grillout/bottleshare tonight. Some really good stuff was opened. Good start to my vacation.
    Never really developed a taste for tequila. Kind of hard to understand how you make a drink out of something that sharp, inhospitable. Now, bourbon is easy to understand.
    Tastes like a warm summer day. -Raylan Givens

  9. #169
    there's a good buck in that racket.
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    s'upp y'all

  10. #170
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Quote Originally Posted by mookie1995 View Post
    s'upp y'all
    Not much apparently.

  11. #171
    Veteran leswp1's Avatar
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Good Evening Lodge!!

    I am up! making progress on my new garden, all without spending a dime. I need to thin so many perennials that I am moving things and you can't tell they are thinned.

  12. #172
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Evening, Lodge. Did my usual routine of brunch/local brewery today. It was dead at the latter, BUT, at one point the only employee was on the patio helping a customer, and the phone rang. I went over to answer it, helped the caller out with his questions, etc. Employee comes in, told him about it, he thanked me. Sure enough, the caller came in a few minutes later, relayed the info I had given him, and the employee told him "Yeah, that was Rube (points to me). He doesn't work here, but if you need to know anything about the place, just ask him." We all had a good laugh over that.
    Never really developed a taste for tequila. Kind of hard to understand how you make a drink out of something that sharp, inhospitable. Now, bourbon is easy to understand.
    Tastes like a warm summer day. -Raylan Givens

  13. #173
    C'mon Q! MarkEagleUSA's Avatar
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Good morning to tLodge!
    Quinnipiac Bobcats
    2012-13, 2014-15, 2015-16, 2018-19 ECAC Regular Season Champions
    2013 East Regional Champions, Frozen Four
    2014 East Regional
    2015 West Regional
    2016 ECAC Tournament Champions, East Regional Champions, Frozen Four
    2019 Midwest Regional

  14. #174
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Good Morning, MEUSA!


    Good Morning to the rest of tLodge!

  15. #175
    there's a good buck in that racket.
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    s'upp y'all

  16. #176
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Good morning Lodge. Such a lovely weekend. A little bummed I wasnít really able to enjoy it. Ankle/foot doing OK. I think the swelling is going down a bit as it hurts a bit on my ankle bone in the boot. Also, the main incision on the inside of my foot is starting to hurt. Not a lot, totally manageable. Just bothersome. Iím going with itís healing.

    My SIL texted me last night that theyíre having my nieceís 21st birthday party on Sunday. It hit me this morning Iím going to have to figure out how Iím going to actually get into their house. Still canít put any weight on the foot. May need to sit on the stairs and push myself up.

  17. #177
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Quote Originally Posted by leswp1 View Post
    In our PHO there was a conscience effort to force actions that would minimize utilization. CHoices were made depending on how it would reflect on the facility's reimbursement not on what would be best for the pt. There was no long term thought. It was all about how to save the $ now and the cost in the future to the pt? Pshaw.This has escalated since medicine switched to the business model. It is not a good fit.

    The separation of personal actions and consequences and the lack acknowledgement of resources. No amount of motivation can overcome lack of resources. The economy may be 'booming' but the social net is shrinking and the divide between those with resources and not is increasing. They try to say if you do everything right then things are attainable but IMHO it is a load of hoo-ey designed to produce failure (which decreases reimbursement). People cost nothing after they are dead. If the person gets too costly and it is difficult for them to get care they die faster. Totally cynical, I know, but the business model has nothing to do with patient outcomes. It has to do with minimizing payout. You set up measures that are impossible. My favorite dichotomy- 'patient satisfaction' with no qualifiers against penalties for doing things that patients think they should have. Give an antibiotic without certain parameters- DING!!! Don't give it and then DING_DING_DING!!! The patient excoriates in the review because they know they need that [x] because they know their body.... either way they manage to keep some of your withhold.
    (there are posts on NP pages I follow where people are asking for hints on how to increase satisfaction numbers when the patient wants something they shouldn't have. And people are responding with all sorts of ways to manipulate data, have staff call, do other stuff. Rarely do you see someone say the obvious- sometimes it is our job to say or do things people don't like. Their being mad or unsatisfied is part of the process)
    I have a cold! Give me a Z-Pack or I'll write a bad Yelp review!


    But no immunizations!
    I gotta little bit of smoke and a whole lotta wine...

  18. #178
    pawn in game of life
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Good Evening, Lodge!

    Great trip to St. Louis and Kansas City. Great food, great beverages, and great baseball. Glad I took the day off as both hubby and I were exhausted. Back to the grind tomorrow and I really do not want to go back.
    Quote Originally Posted by Skeeterman View Post
    Lady Wore Black is a hottie.
    "I love hockey, it is such a great sport. I love how the outfielders use their baseball bats to hit the ball across the ice field, pass the punter for nothing but net shot from downtown." - Unknown

    "No matter what happens in college hockey tournament, the Yankees will not win the World Series this year." - Mr. wore Black

  19. #179
    Veteran leswp1's Avatar
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Quote Originally Posted by Swansong View Post
    I have a cold! Give me a Z-Pack or I'll write a bad Yelp review!


    But no immunizations!
    THis made me laugh! Well played!

    Good evening Lodge!

  20. #180
    C'mon Q! MarkEagleUSA's Avatar
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    Re: Rep Retirement Lodge 201: A State You Don't Expect

    Good morning to tLodge!
    Quinnipiac Bobcats
    2012-13, 2014-15, 2015-16, 2018-19 ECAC Regular Season Champions
    2013 East Regional Champions, Frozen Four
    2014 East Regional
    2015 West Regional
    2016 ECAC Tournament Champions, East Regional Champions, Frozen Four
    2019 Midwest Regional

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