suellen e. 1,352 Views
Joined: Sep 19, '99;
Posts: 23 (0% Liked)
Dear mn, Thank you for your reply. I never knew that case managers were available at the insurance company end for patients. But one doesn't have a choice about the manager, does one? I guess it's luck of the draw. As you say: the patient signs up with an insurance company and so it behooves the patient to understand the terms of the policy. Well, two things about that: 1) The patient signing on with a company may be an employee of a company, and so does not have a choice about the health group to joined (this was the case for me - the going program for healthcare in our medical group was Health Net. 2) If it is a responsibility of those covered to understand the terms of the insurance policy which provides payment for their healthcare, what do you have to say about the insurance company that changes its policies mid-stream, for example changing the formulary lists, or changing the method in which a physician must get permission to use a non-formulary drug for a patient?
I'm glad to have you here to shed light on these perplexing issues. Please stay tuned.
Hi Joy, I just responded to you but I don't think it was sent. I have worked overseas in the South Pacific for many years. I practiced nursing in the Solomon Islands for six years and now am a graduate student in a FNP program in California. If I would qualify for your assignment, I would be happy to be interviewed. I enjoyed every moment of my experience in the islands, plus I learned to speak a new language. I would also like to keep a running conversation going here about the topic of international nursing if possible and if you are interested to do that. It is a requirement in a graduate course that I am taking currently that I do this. If we could reciprocate our school needs on this website, it would be great.
DSHRN, I too am a telephone triage but I work in a busy family practice with a large pediatric population. Some days when I am the only nurse, I will have 70 - 80 calls! I am very interested in your sticker system. Can you fax me a copy? . Thank you.
I was an ER nurse for almost 2 years after 9 years of experience as an RN in med/surg, ICU/CCU, pediatrics, ortho, and OB (mostly postpartum). My experience was helpful, but not mandatory. ER is a wonderful place to work. It is quite challenging because you have to be ready for anything at anytime. I would say that you should take the opportunity to enroll in the 8 week course, and get going in the ER as soon as you can to start getting experience. Just know that you will be asking a lot of questions of other more experienced nurses and doctors. Hopefully you will be surrounded by supportive people who will guide you along. ER is 90% family practice medicine (with a lot of pediatrics) and 10% major emergencies (automobile accidents, major lacerations, hypovolemic shock, ectopic pregnancies, pneumothoraces, drug overdoses, cardiac emergencies). You will learn so much and if you ever want to become a FNP (I am becoming one now) your ER experience will be invaluable. Good luck. Let me know if you desire other information on the subject. I love to talk about it.
You will find ways to assist the patient in his or her physical needs as a result of listening to what is needed, and guided by your nursing textbook knowledge. Also, engage in conversations about what interests he or she. The paraplegic's life has drastically changed and physical activities are no longer the main focus in life. For example, if the patient loved playing basketball before the accident, maybe coaching basketball is now a possibility. Or writing stories. You will discover an aspect of the strength and beauty of the human spirit when you work with these people. I did.
Use an inexpensive toothbrush - one per razor. They work well and keep the caregiver's fingers far away from the sharp razor's edge.
I don't think that the passage of the managed care bill by the house is good news, do you? Legal costs of lawsuits will drive up the already exorbitant cost of healthcare to the point where few of us may be able to afford decent, good quality care - period. This would be shocking and frightening. Could you imagine paying $10,000.00 per year for health care insurance? (I currently pay $3600.00 for a family of three). Increasing one's ability to sue one's HMO would not be healthy for the economy nor would it improve the current strained relationships between the insurance companies, physicians, and patients. Sueing is definitely not the solution. It will not effectively solve the problems we are having with health care. Taking a look to see where we can cut costs would make a difference, and then making a commitment to continue to look at where cuts can be made. Review committees to constantly look at this. What do you think?
I too have seen the Atkins diet work - weight loss happens on the diet. In nursing school (1973) people who were on it were checking there urine daily for acidosis. If ketones were very high, carbs would be added to the diet to reduce the acidotic state. Personally, I have not read studies but there must be some after this many years. Did you check on the net? To me, a much safer diet for weight loss would be to eat less of a variety of foods in an overall well-balanced - foods from all food groups - diet. Regular exercise and 8-10 glasses of water a day are also mandatory. Our bodies need the carbohydrates for quick energy but the exercise is required so that we don't accumulate excess. And then we must commit to this regimen for the sake of our personal health.
I agree with you nursedude, that it is not good news that citizens may be able to sue HMO's if the the Senate and President ok it too. The HMOs will go broke fast. HMOs are going broke now, but the multiple lawsuits are sure to increase the velocity of the process. The thing is that nobody has been able to come up with a solution of how to pay for expensive healthcare. This is a worldwide problem. In countries where there is much less expensive and lower quality care than in the USA, the governments are having trouble paying for it. I say that we continue to deliver quality healthcare at home but lower our spending. How?? No sonograms to verify the sex of infants. Maybe a $150.00 urine culture isn't necessary in many cases of UTI. Of course there are lots more dollar saving ideas if we would just put our heads together and look for ways to save. The changes won't happen overnight, it might take twenty years. What do you think?
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.
Dear Bluesboyj, Have you actually known of or seen the cost of a HMO denied CT scan come from the MD's pocket? I haven't personally seen or known of this. But I have seen a MD paying his staff out of his personal savings to make ends meet. This is kuku.
A nurse who worked for a HMO in the prior authorization pharmacy told me he resigned because he couldn't handle the job ethically, any longer. If he liked a nurse or doctor who called him up to get medicine approval for a patient he would approve it, and otherwise if he didn't like the nurse or doctor. From what he said it was possible to justify a pharmacy decision either way. What do you make of this? Mismanagement? The HMO administration has gotten so large that it has gotten out of hand? The consumer is obviously suffering. How do we solve the problem?
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?
Dear Nursedude, Judith, and others, Thank you for your helpful insights to this mess of a health care system we have. Your last comment Judith about the liability issue is very interesting, although hopefully will be changing soon, as consumers continue fighting back and HMO's become increasingly legally liable for some of their medical decisions. In the family practice where I work, a physician is paid $5 a month to provide whatever medical services are needed during a month for the patient. This is typical, I know. There was a patient who needed suturing of a laceration last week, and this is not enough to pay for the packet of sutures used! Not to mention the cost of sterilizing the suture set, staff to assist, other office overhead. If the cost of medical care is so expensive, how can a HMO have the gall to pay a doctor so little? Is it really greed? Are we living what we read about in the fairy tales to our kids? The greedy kings robbing as many poor people as possible? If this is what is going on, why is it taking us so long to make laws to outlaw this? The $937 million annual CEO profits could pay a few medical bills. I still feel not absolutely certain about how HMOs operate.
Dear Lisi, I've worked in a family practice office for four years now. Even though it's difficult in your office, wash your hands as often as you can. Another possible help, drink plenty of water. I find that drinking 6-8 glasses a day while I'm at work probably helps me not to get sick very often and helps if I do get sick by allowing a milder overall illness. Opening a window or door might help to let in the fresh air and substituting it for the more germ laden air inside the clinic. Let me know how it's going.
Advertise With Us