Saturday, September 5, 2009

Draw the Rainbow

(When you dont know what is wrong with the patient, you draw every color blood tube you can find and send it to the lab for pan testing) I was supprised when on another blog a surgeon stated that he never had any problems with Medicare approving anything. I guess he either does not follow his patients in the hospital of that he has a very restricted practice because we run into it all the time. The usual situation is a patient who has sustained either a severe trauma or horrible infection that requires long term hospitalization. You get them through the acute phase but then there is the long recovery. Medicare will not cover the hospitalization after a certain peroid so then you try to get them to a "longer term rehab bed" but Medicare limits this. The patients only get so many days. So, you end up with the constant dilema. The patient is not well enough to be discharged but according to Medicare is not sick enough to be in the hospital. Before we could come up with some fuzzy diagnosis like "failure to thrive" or some such but that doesn't fly anymore. If you discharge them to a nursing home (Medicare wont pay for that either) and they come back to the hospital, Medicare counts that against you. So, what do you do? You have to come up with a diagnosis that Medicare will accept to keep the patient in the hospital that you can support with a lab or test. We use to just draw a UA or get a chest xray because we could always find an asymptomatic urinary tract infection in an elderly female patient or at least a questionable density on the chest xray to support a questionable pneumonia. But since these are now not reimbursed diagnosis by Medicare as "hospital acquired infections" they do not count. You see our goal is to keep the patients in the hospital until they are well without the patient and the hospital going broke. So, now we draw the rainbow and hope to come up with a documentable diagnosis to keep the patient in the hospital. If you draw enough blood for testing, the patient becomes anemic. Severe anemia is a Medicare approved reason for hospitalization!


SeaSpray said...
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SeaSpray said...

P.S.- And I guess you can lose too because they find ways not to pay the docs too.

it does have to get fixed.

The more I hear about open competition across state borders..the better it sounds..seems like the sensible thing to do.

Good old competition would be the catalyst for quality ins plans and competitive pricing. Gouge the people..lose their business.

Ins companies have to be shaking in their boots that business as usual for them is coming to an end.

In August, I heard the administration wanted to know about all employees who made a million dollars or higher salaries, if they had any parties and if the parties were off site.

It seems to me... that if given a choice to operate under free enterprise or government control..that these companies may be ripe/open to new and fairer ways of doing business. a NJ resident living in a state that has one of the highest auto ins premiums in the country... I would buy out of state ins in a heartbeat and never look back... unless they offered better deals with quality coverage.

SeaSpray said...

TM -I don't know if you'd like this but John Voight (sp?)on Huckabee was just reading something that Thomas Sowell wrote about us losing our freedoms in America & how this administration is changing what America has been like for a few hundred years and is what has drawn so many people to live here.
I had never heard of this writer and so googled him and found this site. Oh-my-gosh...he's GOOD!

And then elsewhere and most recent:
"Listening to a Liar":

or this:

I bookmarked him and am blogrolling.

Hope I didn't offend you with these. Sometimes my enthusiasm for something just bubbles over. I am very much looking forward to reading more. can't believe I've never heard of him until tonight! the other blog I had recommended..a regular commentator(far left)has challenged me with things re: Bush administration, etc. Sometimes his stuff is so far off the mark..I really have to stop and think... but I like the challenge. Oh..who am I kidding..I ALWAYS have to stop and think! ;)

Okay..I know I've been commenting a lot and will slow down now.

Have a great week! :)

SeaSpray said...

Gee... I wonder if it will be any better if we have the health care plan this administration wants to put through. Oh.. silly me.. MDCR is government insurance... and so more of the same.

It seems like one big game... but you have to win..or your patient and/or the hospital loses.

What you describe seems crazy... and wrong... and it must be so frustrating for you.

We patients have no idea what our doctors go through to help us. or does it become second nature after awhile?

I'm really beginning to think that surgeons are the super heroes of medicine because of the stamina and courage you all must have. I'm not trying to flatter or anything..I'm serious.

before I say anything else..I think all docs are important, are courageous and have stamina and do heroic things in all kinds of ways to help their patients.

But it just seems that on top of your clinic/office work (Full time job right there) and scheduled surgeries.. you take call and may have to operate and go without sleep and work all day.. and you have written that you do research and you teach and you have a family and friends. Then of course meetings, additional training, certifications and whatever else you all do.

I know ED docs that have dual careers and they do those 24 hr shifts.. but when they are off.. they are off.

They must train you in surgical residencies to be super heroes. I'm beginning to wonder if surgeon's wear a super hero cape under their white coats in the office and are ready to rip that coat off in a moment's notice and fly out the door?! Next time I see uro doc... I'll have to look down around his knees and see if a superhero cape is showing below his jacket. ;)

SeaSpray said...

I am sure the president is scoring big points with the average uninformed citizen right now.

A lot of it sounds good up front... but what about long term when he is long gone?

Whenever I see Chuck Schumer ... feel greatly annoyed... oh throw Barney in there too.

i was amused to hear the president saying how free enterprise/competition works when Michael More's new film is about the evils of capitalism.