[Mijourney]

TiredMD, I appreciate your comments. As you know, right now most insurance in the U.S. is employer-based. However, more and more people are losing employer-based insurance benefits. I assume that you will be prepared to be paid in other ways besides private insurance - especially, if you plan to do a little charity care and not accept government insurance plans. In the days of old, my understanding is that physicians were paid in alot of creative ways. If the crisis in health care continues to worsen without being abated, I see history repeating itself.

[Nurseboy1]

Originally Posted by CountyRat

Complications are the result of the patient being sick. The sicker the patient is, the more likely he or she will suffer complications. This has been a known truth in medicine since before Hippocrates first sharpened a pencil. The solution is to treat the complication, not stigmatize the provider who is rendering care.

Let's reason this out together. You receive an elderly, obese female with Type 1 DM; poorly controled. She is dying. She needs surgery. NOW! She is a lousy surgical candidate, but, oh gee, there is that "she is dying" thing so, hi-ho and away we go, off to the OR. Guess what? The physiological stress of disease, plus the added stress of surgery (surgery is, after all, controlled trauma) makes hyperglycemia a virtual inevitability. Control with insulin will be initiated, but will be achieved slowly, and with great difficulty, and yes, some danger to the patient. Doctor's fault? Nurse's fault? No. Diabetes' fault. That's one of the reasons its such a crummy disease, but I digress.

A week has passed. You have achieved marginal glucose control. Happy days ahead? Hell no! Hyperglycemia bungles the immune system. Doctor's fault? Nurse's fault? No, no one's fault. Just a fact of mamilian physiology that we are stuck with (unless CMS crafts a regulation changing mamilian physiology. Oh, sorry, another digression.) Now incissional sepsis is a virtual certainty. Gosh! There are two, yes TWO "never events" one hard upon the other! This is an outrage! What is the answer? Punish someone, or treat the infection? Medical tradition says, "treat the infection." CMS says, "punish someone." And in the process, create a disincentive to treat the patients who need the care of doctors and nurses the most!

It is not possible to regulate the laws of physiology away. The sickest people tend to get sicker before they get well (if they get well.) I am just a dumb nurse, but I do know stupid when I see it. This is stupid. This will hurt patients. START TELLING PEOPLE THAT CMS IS AN ASS THAT WILL GET THEM KILLED UNLESS THEY FIGHT BACK NOW!

On our next show, we will discuss JCAHO, and how their intrusions into clinical medicine and nursing (about which they know nothing) ensure that patients receive care that is significantly below the capabilities of providers. Stay tuned.

OMG man you had me rolling. Love your logic, maybe we should mail your post to the CMS office LOL

[Kelly_the_Great]

I think sending that post would be completely appropriate! If CMS faces no opposition whatsoever in their proposals, who's at fault when they bulldoze it through?

Maybe it won't make a difference at all but we could try!

They're accepting comments through June 13th.

Their contact info electronically is: http://www.regulations.gov

or:

By regular mail. You may mail written comments (one original and two copies) to the following:

Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Attention: CMS-1390-P,
P.O. Box 8011,
Baltimore, MD 21244-1850.

[CountyRat]

Originally Posted by Kelly_the_Great

I think sending that post would be completely appropriate! If CMS faces no opposition whatsoever in their proposals, who's at fault when they bulldoze it through?

Maybe it won't make a difference at all but we could try!

They're accepting comments through June 13th.

Their contact info electronically is: http://www.regulations.gov

or:

By regular mail. You may mail written comments (one original and two copies) to the following:

Centers for Medicare & Medicaid Services,
Department of Health and Human Services,
Attention: CMS-1390-P,
P.O. Box 8011,
Baltimore, MD 21244-1850.

Thank you, Kelly. Your post is the best one yet because it provides information that we can use to resist these medically incompet physician impersonators at CMS. I am going to use the information Kelly has provided to share my thoughts with CMS. (Calmly and professionally I hope. I will have to really exert myself!). I urge everyone who reads this to do the same. If doctors, nurses, therapists, and technicians will not make the effort to tell the truth, who will? Who will protect our patients if we are too lazy to act? Our patients do not have the knowledge or experience that we do, so they cannot protect themselves from these frauds (or the empty labcoats with clipboards from JCAHO). It is our responsibliity to stand up together, and now is the time to do it!

DON'T JUST SIT THERE. CLICK KELLY'S LINK AND START TYPING!

[CountyRat]

Originally Posted by interleukin

Damn Well Said, Man!

Interleukin, because they came from you, I am greatly honored by these kind words. I am one of your many admirers, and I am humbled that you would take the time to respond to one of my silly little rants.

PS: Please keep at your writing! You have the gift, brother, and you bless more people than you know. Don't let anything stop you from using that gift.

Stay strong,

C.R.

[CseMgr1]

Originally Posted by Mijourney

TiredMD, I appreciate your comments. As you know, right now most insurance in the U.S. is employer-based. However, more and more people are losing employer-based insurance benefits. I assume that you will be prepared to be paid in other ways besides private insurance - especially, if you plan to do a little charity care and not accept government insurance plans. In the days of old, my understanding is that physicians were paid in alot of creative ways. If the crisis in health care continues to worsen without being abated, I see history repeating itself.

And, even if you are "fortunate enough" to still have employer-based benefits, don't count on them to come through for anyone.

Just this week and barely two months into my new job ("Oh, we have GREAT benefits here", I was told), I was informed by my employer's health insurance carrier that I have a nine-month waiting period before my benefits kick in "due to a pre-existing condition".

How convenient. One of the two main reasons I applied for and accepted this position was the promise of having health insurance coverage. I breathed a collective sigh of relief, thinking that the $100-per-month and up-front fees I have been paying in order to get my foot in the door of my specialist's office and for the priviledge of using up three minutes of their precious time was going to be a thing of the past......



How freakin' stupid and naive could I have possibly been?

My physicians are so "creative" that they only have two words in their vocabulary if you are uninsured and don't have the money: "BEAT it!"

[3rdcareerRN]

To bring this issue back to life... The American Hospital Association has responded to CMS forcefully and thoughtfully. It almost makes me think they listened to their members' nurse employees.

See http://www.aha.org/aha/letter/2008/0...l-cms1390p.pdf