Friday, October 11, 2013

What a Patient Should Know

I think I've been admirably quiet when it comes to the Affordable Care Act.  (Others may disagree. LOL)  However, after just 10 days into the month of October, here are some changes that have already hit the healthcare system that I think every patient should be aware of.

If you come to the hospital bring ALL of your medications with you.   If you are to be admitted on an observation status, Medicare will no longer pay for the hospital to give your medications, unless they are newly prescribed.  This means that my patients who rushed to the hospital with chest pain, but left their Lopressor, Norvasc, Plavix, and Aspirin at home will now be billed for these pills unless their spouse goes home to get them.  These pills will cost anywhere from $20-$200 EACH.  The other option was that the doctor could write them a prescription and they will go to Walgreens in the hospital to get enough pills to last the hospital stay.  This  is not a good option to a patient who just had a three month supply filled, but it is certainly cheaper than paying the hospital itself.  This is an interesting change in mindset, because in the past we gave you OUR pills because then we knew that the pill was truly correct.  I can't tell you how many times I've opened a patient's prescription bottle from home to see several different colored pills.  They had just dumped them all together if the doctor changed the prescription, not realizing that he changed not only the frequency, but the dose also.

Another change is that nurses are now required to chart twice as often on patients who are in observation status.  I don't understand this mindset, other than they want to be sure the patient justifies being there at all.  But in a job where you are lucky to take a potty break, much less a lunch break, this is an interesting challenge added to the day. 

Third, and scariest of all is this:  My hospital system is laying off 500 hundred employees. 


So far they are not eliminating nurses, but I am already anticipating that they will change the patient to nurse ration in an effort to save money.  Obviously, this will affect my job as I currently work all over the hospital covering shortages.  A higher patient to nurse ration means less need for fill ins like me.  Again, while most nurses will rise to the challenge as we are adaptable by nature, this will affect the care you receive.  More patients means less individual care, and I can't tell you how many times I've  had someone tell me their nurse never came to see them.  My answer is this: That usually means there was a much sicker patient that demanded their time.  Be glad you weren't that patient.

Whether the lay offs are nurses or not, your care will be affected.  Less housekeepers means longer to get the room clean between patients, so the longer you will be stuck waiting in the ER with little to no privacy on an uncomfortable stretcher.  It means more housekeeping falling onto the nursing staffs shoulders, because we realize when the housekeepers are being ran ragged trying to get rooms clean, so we end up cleaning our occupied patient rooms ourselves.  Again, affecting the individual time you have with your nurse.  Less dietary workers means longer times to get food to the patients.  Fewer maintenance workers means shoddy equipment, and believe me equipment issues and money to buy new/repair existing equipment has been an issue in every hospital I've worked in.

After being in healthcare for 19 years as of May, I can assure of one basic fact:  If the housekeeping isn't done well, the nurse takes responsibility.  If your food isn't what you like, or doesn't come as soon as you want, the nurse takes responsibility to fix it.  We will even try to do maintenance if the repairman is busy.  It all comes back to your bedside nurse.

Now, while at this time the changes in procedure are in response to Medicare billing changes you need to understand this:  Private insurance always follows Medicare on billing policies.  For example when Medicare changed to reimbursing hospitals a flat rate based on admission diagnosis, private insurance followed. 

Oh, and that brings up an interesting topic.  How will hospitals be paid under the Affordable Care Act?  Here is an example.  I had a patient a few weeks ago who was a physician's assistant.  She has had to stop working because for the last year she has had issues where she suddenly begins "dumping."  This basically means she begins to urinate nonstop, her blood pressure bottoms out, and twice she has ended up comatose on a ventilator.  She has been in every hospital in the Oklahoma City area, and even the Mayo Clinic trying to get an answer.  So far, nobody has come up with a cause.  One of our neurologists felt she should have a PET scan of her thalamus and pituitary gland to see if she perhaps had a tumor there that does not show up on CT or MRI.  Well, the way a PET is normally ordered is when a known tumor is found.  The PET is a follow up to see if it had spread.  In days past the doctor would call the radiologist and ask what he thought, and would he support his decision to do the test.  In fact, the doctor did this and the chief of radiology agreed that in this situation we needed to think outside the box.  Well, here's the kicker:   She couldn't get the PET scan because the insurance would not pay for it without a known previous mass.  While she could do it as an outpatient where she would agree to pay out of pocket if insurance won't cover, we couldn't do it as an inpatient because the hospital would NOT get paid.  So, here is a woman who has lost her livelihood due to a condition that has never been diagnosed.  A doctor thinks outside of the box and tries to see if he can find the root cause.  The INSURANCE decides she can't have the test while in the hospital, and we were hoping to keep her long enough to reproduce the "dumping" so lab work and test could be ran in the process, again hoping to find the root of her illness.

While that may seem like a long and tedious story, here is the most frightening thing I heard during the conversation with the patient.  The doctor said that hospitals will now be reimbursed a FLAT rate on every patient, regardless of diagnosis.  So, whether you come in with appendicitis or a stroke, the hospital gets a certain amount of dollars to treat you per day.  This means that hospitals will have to figure out how to keep costs to a bare minimum so that when they get paid for cheaper hospitalizations, there is some left over to cover the complicated diagnosis.  According to this doctor, and I am not sure where he got his numbers, thirty percent of US hospitals are expected to close their doors within the first three years of the Affordable Care Act.  Here's why this hit me even harder:  This doctor is in favor of the care act saying "Our current system is broken.  We will see if this one is better."  So, here's a doctor in favor of Obamacare stating that THIRTY PERCENT of hospitals don't expect to survive the reimbursement changes.

Wow.  I've gone on and on.  And I don't have an answer.  I do know this:  Big changes are coming to healthcare.  I will stay in nursing, as I know it's my calling from God.  But things will certainly look different.

P.S.  Before this post goes viral courtesy of my mom, I feel compelled to say that I do not know exactly what positions are being eliminated, other than some big administrative ones.  However, there are not 500 administrators in system (and I read an article this morning saying it was closer to 600).  Take away nursing, and I just went with my gut on what positions will be most vulnerable..  My gut can be wrong though!


Martha Dehne said...

Very, very eye opening. Especially from someone seeing it first hand. I'm glad that you will continue your nursing career....we need people like you.

Anonymous said...

thanks for sharing . You are a great nurse and I know you will be dedicated no matter.

Wayne Olmstead said...

Very interesting Blog. I suspect it points out the problems we are facing in our healthcare system with or without the ACA. Also interesting to note that a doctor in Oklahoma is willing to work with the ACA. You didn't say what hospital you work in. It must have had a different protocol for dispensing pill than hospitals most of us have had experience with. We have been charged. Thank you for your dedication to your profession! Wayne Olmstead

Mindy said...

This is scary. Nurses already have to chart more than they can care for their patients, as I've noted in the past ten years as a cancer patient. This is horrifying! We have had many doctors close up shop around here because they can't afford to stay in practice with O's changes. I find it ironic because in my experience, it only raised the cost of the health care of everybody I know, especially those on lower incomes. I personally haven't met anybody, other than someone on total public assistance, that has been helped. One Christian worker(like a stateside missionary) in Montana now is paying HALF of his salary for his health care and will be fined if he stops having it.

Thanks for giving us the facts, even if I can't stand hearing them.

May the Lord give you the strength and grace to keep being a great nurse under harder circumstances.

Crazy Sister said...

Oh boy. I think the public health system in Australia has problems, but I don't think they're that bad. I might be wrong. I'm almost ashamed to admit that we're a very healthy family with private health insurance just in case someone needs a tooth out or something.

Your post makes me want to move to America to volunteer cleaning out hospital rooms, because people need care. :(