I AM FRUSTRATED.... I GIVE UP...

suellen e. · Oct 3, 1999

Dear Nursedude, Would you agree that what is at the heart of the healthcare crisis in this country is that we are pricing ourselves out of the market? Our medical care has gotten so expensive and now we're having a horrendous time paying for it? Please respond. All of us who have been replying here are obviously concerned about each other and about our patients, and the situation we're in. And I'd say we're frightened. Let's keep talking. Thanks.

Ahn · Oct 4, 1999

I live in Hartford, CT - original home of the insurence industry. Think about this! CIGNA Healthcare recently announced that they will begin construction of a 18-hole golf course and luxury hotel and conference center for the SOLE PURPOSE of THEIR EMPLOYEES AND FAMILIES! Now that is Managed Care at it's finest. CIGNA, my healthcare insurence provider/PCS denied my claim for medications that I have been taking regularly for 6 yrs, until the company aurthorized my plan of care. It has taken a week to clear the way to get the medication I need to function normally. For this, I owe to Managed Care and their cost cutting, cookbook for malpractice. Nuff said!

RNGal · Oct 6, 1999

Dear Nursedude,

Thank you so much for your topic. I graduated from nursing school in December. It seems the more knowledge I gain about the profession the more overwhelmed I become. I do not understand everything that is impacted by the insurance companies but I would like to know more. I feel so inadequate sometimes because I fail to meet these sometimes impossible standards that are placed on nurses. Please send some resources. It would e greatly appreciated!

suellen e. · Oct 6, 1999

And just think about it, a family doctor is paid $5.00 a month by your typical HMO to keep a person healthy...this does not cover the cost of the sutures to stitch a wound, let alone payment for the time it takes to suture it.

In the family practice where I work, we are taking on 50-75 new patients per week into the four doctor, 2 FNP practice. In the same breath, we cut back 160 staff hours per week. We are rushing faster and faster to take care of the needs of these patients i.e. calling in new prescriptions, refilling prescriptions, answering patient phone calls, seeing patients. The pace is frenetic. The doctors and FNPs are working an easy 12 hours a day. Most staff are staying at least 30minutes to an hour overtime and there is absolutely NO overtime being paid by our employer. If we would all leave on time, patients wouldn't get needed prescriptions called in, patients with bladder infections wouldn't get calls back the same day, nor would patients with headaches or other pains get calls back either. One physician I work with talked about how holes are burning in her stomach. Doctors are frazzled worse than I've ever seen in my 24 years as a nurse, not to mention how stressed the nurses are. What action can we take to get the pendulum swinging in the other direction? Any insights from CT?

nursedude · Oct 6, 1999

Here you go RNGal:

http://www.abqaurp.org http://www.chcs.org/chcsinfo.htm http://www.cerner.com http://fmciweb.com http://www.globalmanagedcare.com / http://www.ahcpr.gov/data/hcup/drgtab.htm http://www.mcareol.com/inmcodic.htm http://www.cmhc.com/articles/glossary.htm http://www.shriver.org/Service/CommunityFamilyServices/ManagedCare/index.htm http://www.mcres.com / http://www.hcfa.gov / http://healthcare.about.com/business/industries/healthcare/msub21a.htm http://www.healthlawyers.org / http://www.familiesusa.org/managedcare /

Sorry, I have more, just don't have time to post them all. Will try to do so @ a later time.

ND

TraumaNurse30 · Oct 7, 1999

nursedude: I understand your frustration. I work in a Level 1 trauma center that made over 30 million dollars last year. However this year I could not begin to tell you the cuts that have been made because of the money we are losing this year. The problem is not only Managed Care, but the Health care refrom of 1992. We have had to redo all of charging systems because the Federal Government has decided what a hospital can charge a patient for and what they can't. Basically they are wanting us to give more (ie. supplies, crutches, walkers, etc.) and then will not allow us to charge for them. They have even gone so far as to make it a federal offense if you are caught charging for these items. And you can be caught because every employee is inserviced once a year on Corporate Complianc which insures that every employee knows what to report and how to report it.

I will say don't give up. We work in a wonderful profession. I can't think of anything I would rather do. We have to hang on and stick together, which is something that Nursing in general has not done very well in the past.

suellen e. · Oct 8, 1999

Back to your September 29 posting Nursedude......it's easy to understand that there are those of us who do not understand what is going on in health care today. There's a lot of chaos right now so it's not an easy thing to comprehend. And basically it's a free market out there. The employers are looking for the HMO who will provide them with the best deal for employee health care. Wouldn't you if you were an employer? So the employers are doing what any reasonable citizens born in an economic democracy would do. I can understand your frustration but you must remember that we're all bozos on the same bus trying to understand and make the situation better for us and for everybody. It's going to be real interesting to see what happens next especially after today's passage in the House of Representatives of the Patient's Bill of Rights. If consumers start sueing HMOs,the consumers will undoubtedly be paying the yet higher cost of health care. I'm on your team nursedude.