COVID: I'm ready to leave the hospital until the end of the pandemic guilt

[CardiTeleRN]

Hello!

I am considering leaving the hospital until the end of the pandemic. Not necessarily because of the ill patients. Mostly because of the politics. I understand that there is a shortage of staff for COVID units. My issue is, the hospital I work for is constantly creating new COVID units for patients that are asymptomatic. I've learned these hospitals are getting additional funding from the relief programs put in place by the government. The hospitals gain additional funding if the patients are placed on vents as well. I've noticed MDs and rr therapists are forcing us to place them on vents even if they do not meet the criteria.....

I am becoming extremely overwhelmed and am sick of what I am seeing. I hate how the system is taking advantage of these extremely difficult and emotional taxing times...I don't want to be a part of this anymore.

Am I wrong?

[CardiTeleRN, BSN]

1 minute ago, DaveMHA-RN said:

Calm down and check your grammar. 

You are assuming people would make complaints.

But you don't know the culture in CardiTeleRN's hospital, everyone may be afraid. 

Thank you! As I responded to that claim, we have complained to managers. We have questioned certain orders and consults as to the need for it. We are always ignored or ultimately blown off. It is getting out of hand which is why I said I just want to leave the hospital during the pandemic because of this. I just feel bad I can’t help the patients like they deserve to be helped =<

[MunoRN, RN]

6 minutes ago, CardiTeleRN said:

How do you know we haven’t? We have brought our complaints to management. We are always taking nonsense from MDs when we question certain orders or consultations. So do not assume. Why are you posting things as if fraud does not exist in health care? I’m convinced you are actually a part of the problem. That’s unfortunate. 

I'm not sure why you would be only sharing your concerns of fraud with the people supposedly perpetrating the fraud.

Medicare fraud would be reported to CMS: https://www.cms.gov/About-CMS/Components/CPI/CPIReportingFraud

[guest584920]

2 minutes ago, CardiTeleRN said:

How do you know we haven’t? We have brought our complaints to management. We are always taking nonsense from MDs when we question certain orders or consultations. So do not assume. Why are you posting things as if fraud does not exist in health care? I’m convinced you are actually a part of the problem. That’s unfortunate. 

Excellent post! 

I have noticed macawake makes a lot of assumptions about people and quickly jumps to conclusions.

And you are spot on about him or her being part of the problem by being in denial about healthcare fraud. And being in denial about malpractice for that matter. 

[MunoRN, RN]

42 minutes ago, Jack Peace said:

Yes, you are correct. And those "presumed positive" cases are INCLUDED in the overall "cases" numbers. All it takes to be considered in the presumed category is one symptom such as cough, sob, fever, etc. 

Using Covid-positive billing coding or reporting criteria has never included a single generic symptom.  Early on when testing wasn't widely available or reliable clearly defined clinical diagnosis criteria was often used, which included a combination CT findings, symptoms, organ function criteria, etc, this was comparable to current testing in terms of accuracy.

[MunoRN, RN]

Hospitals lose money caring for COVID medicare patients, the more aggressive care these patients need the more they lose, the weighted reimbursement adjustment only slightly reduces the amount of money lost.  So the claim is that they are intentionally treating non-covid patients or intentionally providing more aggressive care than necessary to make more money doesn't make any sense.

[Tweety, BSN, RN]

On 11/22/2020 at 6:38 PM, CardiTeleRN said:

I've noticed MDs and rr therapists are forcing us to place them on vents even if they do not meet the criteria.....

I don't know a respiratory therapist in all my years of nursing that would do this.  This is criminal and if bumping it up the chain of command didn't help and it's still going on then the next step as suggested in this thread should be taken.

There is a lot of myths out there about funding.  At the end of the day, there is some fraud out there (our senator here in Florida was part of a massive exposure of medicare fraud in the 90's by the now named HCA organization) but the overwhelming majority of us are ethical.  I know my organization which includes facilities with 3200 beds publishes their covid data daily.  For the last week it's been steady at about 100 patients and 9 or 10 vented patients.

We have a reporting system, some number to be able to report our facility anonymously if we suspect fraud.

Good luck.

https://www.usatoday.com/story/news/factcheck/2020/04/24/fact-check-medicare-hospitals-paid-more-covid-19-patients-coronavirus/3000638001/

[macawake, MSN]

22 minutes ago, CardiTeleRN said:

How do you know we haven’t? We have brought our complaints to management. We are always taking nonsense from MDs when we question certain orders or consultations. So do not assume. Why are you posting things as if fraud does not exist in health care? I’m convinced you are actually a part of the problem. That’s unfortunate. 

I very much doubt that I’m part of any fraud problems you might have.

I am assuming that you haven’t taken your information to the proper authorities based on what you wrote in OP. Mananagement at the same hospital where you allege physicians and respiratory therapists are systematically forcing you (and other nurses?) to place patients who do not meet the criteria on vents, are not the proper authorities. 

[Emergent, RN]

I do know that Covid positive patients who've really died of other causes, have had covid put as a cause of death, and included in statistics. That is definitely happening, I know specific cases. +covid was really an incidental finding. 

But patients aren't being intubated unless necessary. Early intubation isn't a current treatment modality. 

(Yes, there is voter fraud, but enough people hate the current president that it wasn't needed,  plus people on both sides would be happy to cheat ?)

[guest584920]

9 minutes ago, Tweety said:

We have a reporting system, some number to be able to report our facility anonymously if we suspect fraud.

Good luck.

https://www.usatoday.com/story/news/factcheck/2020/04/24/fact-check-medicare-hospitals-paid-more-covid-19-patients-coronavirus/3000638001/

Not for profit healthcare systems are in a tough situation they have to follow what the government deems "best practices' or they run the chance of loosing their tax exempt status.

If the government says vents are best practice even if BiPAP works better physicians will feel pressured to use the vent.

This how the opioid crisis started. The government started linking payments to patient satisfaction surveys and one of the domains was pain. So providers were writing prescriptions for opioids like candy. 

I think we are seeing a lot of this with COVID. 

[Hoosier_RN, MSN]

32 minutes ago, DaveMHA-RN said:

Excellent post! 

I have noticed macawake makes a lot of assumptions about people and quickly jumps to conclusions.

And you are spot on about him or her being part of the problem by being in denial about healthcare fraud. And being in denial about malpractice for that matter. 

Macawake isn't in the US, so not part of US medical fraud. I will ask why would you report fraud to the persons who are part of the fraud chain that you're claiming? Why not go to your state board of health, and CMS? Just asking, as this is what makes the most sense to me

[Tweety, BSN, RN]

2 minutes ago, DaveMHA-RN said:

Not for profit healthcare systems are in a tough situation they have to follow what the government deems "best practices' or they run the chance of loosing their tax exempt status.

If the government says vents are best practice even if BiPAP works better physicians will feel pressured to use the vent.

This how the opioid crisis started. The government started linking payments to patient satisfaction surveys and one of the domains was pain. So providers were writing prescriptions for opioids like candy. 

I think we are seeing a lot of this with COVID. 

I didn't know the government is saying vents are best practice.  I work for a non-for-profit and it seems we try very hard to keep patients off the ventilator.  However, we haven't seen much of a surge in hospitalized patients yet and I work the floors and not the Covid ICU, but as I stated earlier out of 100 positive patients only 10 of them are on vents.

I do agree with the idea that pain control lead to over-prescription.  It started long before customer satisfaction when patients were winning lawsuits for inadequate pain control.  Now they are winning law suits for becoming addicts....and so it goes.

[MunoRN, RN]

9 minutes ago, DaveMHA-RN said:

Not for profit healthcare systems are in a tough situation they have to follow what the government deems "best practices' or they run the chance of loosing their tax exempt status.

If the government says vents are best practice even if BiPAP works better physicians will feel pressured to use the vent.

This how the opioid crisis started. The government started linking payments to patient satisfaction surveys and one of the domains was pain. So providers were writing prescriptions for opioids like candy. 

I think we are seeing a lot of this with COVID. 

The government doesn't promote proactive intubation, the NIH treatment guidelines include that intubation should only be considered a salvage therapy since in mild to moderate cases intubation results in poorer outcomes.