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

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

    The boss and I are going on an Alaska cruise at the end of August plus a pre-cruise Denali deal and a couple of extra days in Vancouver on the back end. This will be the first time Mrs. GE will miss going to the fair. Ever.
    Granted she grew up (and her mom still lives) between Como Park & the Fairgrounds but still....that's a heck of a run.

    Minnesota's Pride On Ice: 1974, 1976, 1979, 2002 & 2003 NCAA National Champions


    And the preacher said, you know you always have the Lord by your side
    And I was so pleased to be informed of this that I ran
    Twenty red lights in his honor
    Thank you Jesus, thank you Lord

    ~Mick Jagger/Keith Richards

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

      Originally posted by leswp1 View Post
      It is structured to fail. Used to be discharge planning was a huge focus of the nurses' job. Then, with the roll 'em in and roll 'em out fast as you can mentality, this has almost totally disappeared. No longer a proactive approach but a reactive one. Mind boggling to me as a good discharge plan forestalls all sorts of over utilization afterwards and the way reimbursement is structured they lose cash if the person is readmitted.

      Good Morning Lodge!
      Well, I think the intent was that the slashing of payments to the hospital for re-admissions would incentivize the hospital to plan the discharge in such a way as to reduce the chance of said re-admission. And the CCMs do a lot of work with the discharge planning. Unfortunately, that usually starts and stops with "discharge to SNF" or "discharge to home". The bulk of their time is utilization review and making sure insurance/Medicare approve treatment so they get paid. Once the patient goes to a rehab or nursing facility they're no longer the hospital's problem, and once they're discharged to home the hospital absolutely does not have the resources to follow up beyond - maybe - a token phone call. CMS has been pushing states and hospitals to adopt the ACO program (Accountable Care Organization), but short of that there isn't much follow-up. And ACOs aren't everywhere, are only for elderly that meet certain narrow criteria and aren't mandatory. And not to get political, but when you have like 40% of the country screaming "OBAMACARE SUCKS END IT ALL" and 40% screaming "NO ITS PERFECT DON'T CHANGE A THING" you get ... this...

      My hospital is an ACO hospital, so I know our elderly patients are at least monitored. The last hospital my mother was admitted to is similarly an ACO facility, so I spent some time with the assigned case manager and social worker. But even their staffs are overworked. In most of their cases, if the patient is receiving any kind of institutional care (in facility, home hospice, etc), their work consists of a bi-weekly phone call and maybe 1-2 in-person visits. I don't know if they pay more attention to ACO patients who don't have that level of care.
      Last edited by Swansong; 06-20-2019, 01:54 PM.
      I gotta little bit of smoke and a whole lotta wine...

      Comment


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

        Back from my post op. Big, honkin’ cast is gone. Replaced by a bigger, heavier boot! Seriously, I can barely move it. The last couple of days my heel has been hurting. Turns out one of the incisions is on my heel and that’s what hurt. It stings. A lot. More now. Not much they can do about it. When they took off the cast and bandages, it was bleeding. So they re-wrapped it and put a cool ace bandage and then the boot. No new cast. But this boot, man, it’s tight and heavy. And has one of those pump mechanisms like those Reebok sneakers from years ago. At least I can remove the boot when I go to bed.

        They were pretty happy to see how it looked. It’s swollen but not a lot. I go back July 1 to get the stitches taken out. Hopefully they’ll allow me to put weight on it at that point. Maybe not. They were also happy and impressed that I stopped the Oxycodone so son. Gave me the ok to start taking Advil now. Took two in the car one the way home. And now, even though I can’t put any weight one it or get it wet, I can take a shower. I bought one of those cast covers to use. Thank God.

        So, I asked if they were in touch with the short term disability case manager, he said no. Huh?? In the car on the way home, I called them and the woman was like “OMG, no one called? I see here that there was a task listed to contact you on June 17. No one called?” Um, no. And my short term disability was supposed to have started on the 19th. So she retroactively got it to start yesterday and to end on July 21. No questions. I could’ve said make it two months. How annoying is that? The. She said “when is your post op appointment?” I told her I had just left there and that’s how i found out no one called. Told her I was going back on July 1, she said they would reach out the week of July 8. Thank God I called because I might not have been able to get paid. Annoying! ::shakes fist::

        Comment


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

          Jebus that's frustrating.

          Regarding your actual foot - isn't it incredible what our bodies can handle and recover from?
          I gotta little bit of smoke and a whole lotta wine...

          Comment


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

            Originally posted by Swansong View Post
            Well, I think the intent was that the slashing of payments to the hospital for re-admissions would incentivize the hospital to plan the discharge in such a way as to reduce the chance of said re-admission. And the CCMs do a lot of work with the discharge planning. Unfortunately, that usually starts and stops with "discharge to SNF" or "discharge to home". The bulk of their time is utilization review and making sure insurance/Medicare approve treatment so they get paid. Once the patient goes to a rehab or nursing facility they're no longer the hospital's problem, and once they're discharged to home the hospital absolutely does not have the resources to follow up beyond - maybe - a token phone call. CMS has been pushing states and hospitals to adopt the ACO program (Accountable Care Organization), but short of that there isn't much follow-up. And ACOs aren't everywhere, are only for elderly that meet certain narrow criteria and aren't mandatory. And not to get political, but when you have like 40% of the country screaming "OBAMACARE SUCKS END IT ALL" and 40% screaming "NO ITS PERFECT DON'T CHANGE A THING" you get ... this...

            My hospital is an ACO hospital, so I know our elderly patients are at least monitored. The last hospital my mother was admitted to is similarly an ACO facility, so I spent some time with the assigned case manager and social worker. But even their staffs are overworked. In most of their cases, if the patient is receiving any kind of institutional care (in facility, home hospice, etc), their work consists of a bi-weekly phone call and maybe 1-2 in-person visits. I don't know if they pay more attention to ACO patients who don't have that level of care.
            From what I thought I knew the hospital eats any readmits (global fee) if they are readmitted. It seems to have changed nothing. They are willing to roll the dice. They also are ridiculous about readmission and will hold people in the ER, repetitively see them and send them home rather than re-admit.
            We were involved with the ACO- it was a scam to reimburse as little as possible for anything. They made the measures close to impossible to meet or if you met one it meant you probably couldn't meet another. Most of the Docs attempted to opt out because it punished you if you took patients who were non-compliant (same thing for the tiering thing- if you are willing to take complex or non-compliant patients all you patients suffer because the code you higher)

            Originally posted by Scarlet View Post
            Back from my post op. Big, honkin’ cast is gone. Replaced by a bigger, heavier boot! Seriously, I can barely move it. The last couple of days my heel has been hurting. Turns out one of the incisions is on my heel and that’s what hurt. It stings. A lot. More now. Not much they can do about it. When they took off the cast and bandages, it was bleeding. So they re-wrapped it and put a cool ace bandage and then the boot. No new cast. But this boot, man, it’s tight and heavy. And has one of those pump mechanisms like those Reebok sneakers from years ago. At least I can remove the boot when I go to bed.

            They were pretty happy to see how it looked. It’s swollen but not a lot. I go back July 1 to get the stitches taken out. Hopefully they’ll allow me to put weight on it at that point. Maybe not. They were also happy and impressed that I stopped the Oxycodone so son. Gave me the ok to start taking Advil now. Took two in the car one the way home. And now, even though I can’t put any weight one it or get it wet, I can take a shower. I bought one of those cast covers to use. Thank God.

            So, I asked if they were in touch with the short term disability case manager, he said no. Huh?? In the car on the way home, I called them and the woman was like “OMG, no one called? I see here that there was a task listed to contact you on June 17. No one called?” Um, no. And my short term disability was supposed to have started on the 19th. So she retroactively got it to start yesterday and to end on July 21. No questions. I could’ve said make it two months. How annoying is that? The. She said “when is your post op appointment?” I told her I had just left there and that’s how i found out no one called. Told her I was going back on July 1, she said they would reach out the week of July 8. Thank God I called because I might not have been able to get paid. Annoying! ::shakes fist::
            Yikes!

            Comment


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

              Originally posted by JF_Gophers View Post
              Morning.

              The wife has approved a MN state fair trip this year. Likely it will be on the last weekend as that is already a long one due to the holiday.
              I usually go that last weekend. Most have gotten it out of the way, so usually smaller crowds, depending on weather. I'm in at 10am or so, out by 3ish, when and if the crowds start to swell.
              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

              Comment


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

                Good morning to tLodge!
                Quinnipiac Bobcats
                2023 National Champions
                ECAC Regular Season Champions: 2012-13, 2014-15, 2015-16, 2018-19, 2020-21, 2021-22, 2022-23, 2023-24
                ECAC Tournament Champions: 2016
                East Regional: 2013 (Champions), 2014, 2016 (Champions), 2023 (Champions)
                Northeast Regional:

                West Regional: 2015, 2021
                Midwest Regional: 2019, 2022
                Frozen Four: 2013, 2016, 2023 (Champions)

                Pass complete. Lipkin has a man in front! Shot... SCORE!!!

                Comment


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

                  s'upp y'all
                  a legend and an out of work bum look a lot alike, daddy.

                  Comment


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

                    Good Morning, MEUSA!
                    Good Morning, Mookie!


                    Good Morning to the rest of tLodge!
                    sigpic

                    Let's Go 'Tute!

                    Maxed out at 2,147,483,647 at 10:00 AM EDT 9/17/07.

                    2012 Poser Of The Year

                    Comment


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

                      Originally posted by leswp1 View Post
                      From what I thought I knew the hospital eats any readmits (global fee) if they are readmitted. It seems to have changed nothing. They are willing to roll the dice. They also are ridiculous about readmission and will hold people in the ER, repetitively see them and send them home rather than re-admit.
                      We were involved with the ACO- it was a scam to reimburse as little as possible for anything. They made the measures close to impossible to meet or if you met one it meant you probably couldn't meet another. Most of the Docs attempted to opt out because it punished you if you took patients who were non-compliant (same thing for the tiering thing- if you are willing to take complex or non-compliant patients all you patients suffer because the code you higher)

                      Yikes!
                      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.
                      I gotta little bit of smoke and a whole lotta wine...

                      Comment


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

                        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!

                        Comment


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

                          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).

                          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...

                          Comment


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

                            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)

                            Comment


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

                              Good morning to tLodge!
                              Quinnipiac Bobcats
                              2023 National Champions
                              ECAC Regular Season Champions: 2012-13, 2014-15, 2015-16, 2018-19, 2020-21, 2021-22, 2022-23, 2023-24
                              ECAC Tournament Champions: 2016
                              East Regional: 2013 (Champions), 2014, 2016 (Champions), 2023 (Champions)
                              Northeast Regional:

                              West Regional: 2015, 2021
                              Midwest Regional: 2019, 2022
                              Frozen Four: 2013, 2016, 2023 (Champions)

                              Pass complete. Lipkin has a man in front! Shot... SCORE!!!

                              Comment


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

                                Good Morning, MEUSA!


                                Good Morning to the rest of tLodge!
                                sigpic

                                Let's Go 'Tute!

                                Maxed out at 2,147,483,647 at 10:00 AM EDT 9/17/07.

                                2012 Poser Of The Year

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