No More Overtime!

Published

Specializes in Registered Nurse.

I was informed CMS has cut back on reimbursement for dialysis services and as a result the dialysis monopoly that I work for, will now look at cost to see what they can cut.

As an, RN, staffing is terrible. They hire technicians, but they can't perform the nursing required. Social workers and dietitians appear to have it good. Everything seems to be delegated to the RN. Insurance forms, pharmacy request, Plans of care, and so on.

Now no overtime, and I know many of the nurses put in extra hours and don't charge for them because we fear getting in trouble with management. There's no way to finish the documentation unless we donate our time, or get fired for not being in compliance. No union in my state. Some states have unions, same company.

May I suggest where to save cost? Top heavy management. Area manager, operations manager, clinic managers, regional managers. So many managers to answer to I don't know who manages what anymore. CEO's making big time $$$ on the backs of RN's and Technicians.

Enough Said. :banghead:

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I totally agree. I HATE being a dialysis nurse for this reason very reason. The hours and staffing is horrible. I am looking to get into going to another specialty asap. So many meetings telling us about cost cuts and no overtime it's just a huge disgrace. They alter our hours to prevent us from doing overtime without any regard for our personal time.

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Specializes in Dialysis.

Hmmm. CMS froze rates for dialysis for 2014 and both Fresenius and Davita stock rose in value at the news. Overtime is part of federal labor law and if your employer refuses to pay the NLRB has a nice surprise for them.

CMS to phase in controversial Medicare payment cut to dialysis providers | Modern Healthcare

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Specializes in Dialysis.

[h=1]I didn't realize the link requires registration so here is the article.

"CMS to phase in controversial payment cut to dialysis providers[/h]

By Beth Kutscher

Posted: November 22, 2013 - 5:45 pm ET

Tags: DaVita, Fresenius, Medicare, Payers

In what is likely to be a relief to dialysis providers, the CMS decided to phase in the controversial payment cut to dialysis providers over a three- to four-year period.

Moreover, overall payments for 2014 will remain the same, according to the final rule issued Friday (PDF).

A tax bill passed in January calls for the rebasing of dialysis rates to better reflect decreased utilization of expensive anemia drugs that have been linked to safety concerns. But the industry has lobbied heavily against the cut, arguing that the drugs themselves have become more expensive and more drugs are being added to the bundled payment. [TABLE]

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The final rule also authorized a 50% increase to the home dialysis training add-on payment and strengthened the Quality Incentive Program, which penalizes providers who don't meet certain performance standards.

A report last month from Moody's Investors Services said having the 11.9% cut phased in over three years is the best-case scenario for the industry because it will be countered by growth in the dialysis sector and marketbasket adjustments.

Shares of Denver-based DaVita HealthCare Partners, one of top two U.S. dialysis providers, were up 12% in after-market trading within the hour after the CMS posted the rule. Competitor Fresenius Medical Care, based in Germany, was up 3%."

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Specializes in Dialysis.

I agree completely with overweight of so many managers, I have worked for of both of the "Big" dialysis companies, and it's the same for both of them in that there are way more managers than floor staff. In my experience , most managers had been climbing the management tree, and couldn't even do dialysis anymore!

I now work in a hospital owned system, we have a clinical director,a middle manager, then the CEOof the outpatient division, who reports directly to the Hospital System CEO.

Much better system,in my opinion!

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Specializes in Registered Nurse.

There is no way to win. Stay and finish the job and I could get disciplined for overtime. Leave and not complete the compliance documentation and I may get disciplined for incomplete documentation. I was instructed to start later if I will be caring for patients later in the day, instead of coming in early. So I have my early days and late days. Also, in order to avoid legal action, they say overtime can only be approved by an area manager. Of course, if one has to go up that high in the ladder, it will be denied, if your lucky enough to be able to find one to explain why you will need to stay overtime.

Most of the overtime is the result of repetitive request from management for completion of their spreadsheets. Also, massive amounts of paperwork patients must sign in order for the company to prove they are providing numerous education requirements by cms, so I'm told. The education component is impossible to cover. There are series of modules and quizzes and so on. The education modules are created for people in grade school, not grown adults. Some of it, is just common sense and insulting to the learner. Then there's the preparation for meetings and Quality Indicators with guess what? Spreadsheets, and Spreadsheets and Spreadsheets. Why do we even bother with computerize charting with all this data entry requirement to spreadsheets. "Tools", they call them. Ridiculous. The tools only benefit the management that does not know how to gather data by looking at the software used to document patient care. I don't want overtime, I want to go home! :madface:

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There is no way to win. Stay and finish the job and I could get disciplined for overtime. Leave and not complete the compliance documentation and I may get disciplined for incomplete documentation. I was instructed to start later if I will be caring for patients later in the day, instead of coming in early. So I have my early days and late days. Also, in order to avoid legal action, they say overtime can only be approved by an area manager. Of course, if one has to go up that high in the ladder, it will be denied, if your lucky enough to be able to find one to explain why you will need to stay overtime.

Most of the overtime is the result of repetitive request from management for completion of their spreadsheets. Also, massive amounts of paperwork patients must sign in order for the company to prove they are providing numerous education requirements by cms, so I'm told. The education component is impossible to cover. There are series of modules and quizzes and so on. The education modules are created for people in grade school, not grown adults. Some of it, is just common sense and insulting to the learner. Then there's the preparation for meetings and Quality Indicators with guess what? Spreadsheets, and Spreadsheets and Spreadsheets. Why do we even bother with computerize charting with all this data entry requirement to spreadsheets. "Tools", they call them. Ridiculous. The tools only benefit the management that does not know how to gather data by looking at the software used to document patient care. I don't want overtime, I want to go home! :madface:

ND:

Yes, when I was a police officer, I dealt with many administrators and dingbat managers who were afraid of their own shadow. You would think as cheap as Davita happens to be, they would be reducing their management work force. As a trained Economist, I have noticed that most social workers lack basic business and reasoning skills. Yes, some in management were great at their positions, but, more often than not, many were clueless.

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