With regard to Medicare:

Just yesterday, I was taking care of a patient who had the second part of her cardiac stress late in the morning. The plan was that IF the stress test turned out ok, she could go home that day.

Well, she finished her test and then came back to her room to wait for the doctor to read the results of the test and let us know whether she could go home. We found out she could go home at about 14:30 in the afternoon. Shortly thereafter, the care manager rushed up to me and said we absolutely had to discharge the patient no later than 16:00.

I asked why.

I was told that according to Medicare regulations, the patient could only be in “inpatient” status in the hospital for no more than 48 hours. If she were there longer, the hospital would lose significant reimbursement from Medicare. The care manager did not know whether this was a new rule, but she DID say that the government has become very strict recently with Medicare reimbursement rules so everyone is having to cross their Ts and dot their Is carefully.

Let me tell you: there are 50,000 things that can happen that can impact when a patient gets discharged from a hospital. And now we have to worry about whether we can get a patient discharged before this random 48 hour designation.

What if the doctor couldn’t read the results as quickly?

What if the patient got done with the test, came back to the room, and suddenly developed nausea that required us to delay their discharge?

I asked how the case manager keeps it all straight. She showed me a thick book that has page after page after page of tiny print that lists the 253 reasons why a patient can be classified as being in “Intermediate Care ” status according to Medicare.

It makes you dizzy. And this is what we are dealing with now – constantly having to evaluate NOT THE PATIENT, but what is happening to the patient to make sure they are classified properly for Medicare purposes. The case manager said it drives the doctors into an utter tizzy. The doctors just know that their patient needs to be in the hospital and needs to be given a certain level of care. They have neither the time nor the patience to scour through a big notebook to make sure they are doing everything according to Medicare dictates.

It makes me wonder: how bad will all of this get if we go to a nationalized health care system?

They will try to blame you, in the end, out of desperation. Just as they do with the military and with Republicans. But we’ll try to cut them off at the knees so they bleed out on the floor still yelling about their Utopia ; )

I would assume (and it is definitely an assumption) that if the $750 reimbursement is true, it would only be the reimbursement to the actual surgeon. It would not be the reimbursement to cover the cost of nurses, therapists, etc. Prep-time and the surgery would take a minimum of two hours. I have never been involved with an amputation surgery but I would suspect that the pt. would need to be in the hospital for at least one week plus extensive therapy.

I also have NOT heard anyone mention anything about doctors being paid to much. I think it is because everyone is so overwhelmed with what the health care reform will mean for themselves and family members as patients. Few people have thought much about what this will mean to health care workers, insurance employees, the increase in the growth of the federal government, the logistics, and so forth.

I believe that if and when the public starts becoming more familiar with what this will all mean and they understand that it will result in the decrease in pay for health care workers, they won’t really care. There seems to be a great deal of class warfare so people will simply say, “So what if doctors make less,” not understanding that we already have a nursing shortage, and if nurses are going to paid less, there will be fewer nurses . . . .

Deana

P

I needed to have been there to see the impact on the audience.

However, even though the military is viewed favorably by most Americans, it doesn’t stop the Left from subverting public opinion on this score and it sure didn’t stop them in Vietnam. They will try to whip people’s emotions in line, but they often will decide not to depending on how hard the job is.

Deana…can you shed light on this?

How about Obama’s tonsil removal instead of medication or $50,000 for an amputation comments? You don’t think those were income/greed inferences?

I agree that we haven’t heard any “doctors make bundles and bundles of money” comments, but I think those items were definite “cloaked” accusations. “Everybody” knows all doctors are rich….but what can you do – we need them!

The Dems need the AMA on their side – out and out criticizing of doctors is not going to win points. At this point, it appears that doctors are critical of the AMA for it’s support of the health care bill – stirring up antagonism would not be advisable.

More and more doctors are opting out of taking Medicare/Medicaid patients, according to what I’ve been reading. If they respond by making it mandatory, there _will_ be trouble, I think.

Nationalize the stage, Sadie ; ) Why need exit when you can own it like Great Stalin Daddy did!!

I wonder why. Perhaps because polls hold them in very high regard, higher than the US military even I recall.

Danny – Yes, indeed, intelligence and stupidity are NOT mutually exclusive. This is one of the reasons why I was so shocked prior to the election at the number of people who were just sure that Obama was smart because he was a Harvard trained attorney. That doesn’t guarantee anything.

And no, the physician did not mention what would happen to her salary should this atrocious bill pass. I personally believe the public does not care about that. Many people will just say that doctors make too much anyway. What people don’t realize is that millions of therapists, nurses, and other personnel also will have our salaries reduced. Danny, I am a new nurse making a new nurse salary but I’m telling, I can’t afford to make much less. If that happens, I will have to make a decision on whether or not I can continue to be a nurse.

Y – Your paragraph that started “Only a strong and shocking psychological blow, to the very survival of the body or mind, would be enough . . .” was spot on. My mom and I were talking the other night about the exact same thing. We wondered what sort of shock would have to happen to shake people out of their stupor. The “drip, drip, drip” of outrages isn’t going to cut it for most people – it will take something large and unimaginable.

Sadie – I was encouraged to hear your account of what happened at the beauty salon. If these types of people are getting concerned, that is enormous. And powerful. It is one thing when we “blog heads” get worked up about something – we are hyper aware of the details. But it is quite another when people who aren’t plugged in are getting worked up. That has to be alarming Washington.

Charles – Your point is well taken. If Washington were doing its job, no one would hear a peep. The fact that people who have never been politically engaged are interested enough to start reading dreadful bills and attending town hall meetings simply illustrates how terrible the President and Congress are doing.

Deana