Problem facing healthcare

typoagain · Mar 1, 2012

i think that healthcare is extremely over-managed....by politicians. we are facing massive changes mandated by the current administration. changes that were written in closed door meetings, with very little input from the healthcare community. and written by politicians who are constantly worried about keeping their jobs, and advancing their personal agenda, and their party's agenda.

i'll give you a couple of example of the unforeseen problems that are being created by this system with the recent changes in the healthcare laws. these are events that happened to me personally just last week. plus they only deal with one very small section of a huge and extremely complex law. a section called

hcaps.

example #1. as we all know women who give birth sometimes get very emotional due to their hormones being all out of whack. we recently had a mother who decided that she and her baby needed to go home ama-21 hours after giving birth. and to make it even more complex, the baby was combs+. needless to say the doctor was not willing to write discharge orders, something that i personally agreed with.

example #2. i had a mother who had a baby that was 6 weeks old and rsv+. the baby had spend 19 days in the nicu at birth with respiratory problems. she was demanded that we sedate the baby so that she could get some rest. she also wanted us to give the baby for cough suppression-something that would drastically increase the baby's risk for pneumonia, and that the doctor would never do.

now is where you ask what that has to do with over regulation? actually it is simple,

hcaps.

hcaps is a survey that covers patient satisfaction. low scores can cause a hospital to loose 30% of their medicare/medicaid reimbursements. and that can cost a hospital millions every year.

now, do you think that either of the people i mentioned are going to give the hospital good scores?

sure, hospitals are going to try very hard to get good scores by keeping patients happy. but don't you think that this will pressure hospitals, doctors and especially nurses to put the patients happiness before what is in the best interest of the patient?

sure, we can inform the patient of the risk, but is the patient in the best shape emotionally to make an intelligent choice? what about when someone else is making the choices for the patient and is making choices based on emotions, not facts.

and what if the patient wants something (i.e. medications) that only a doctor can order, and the doctor does not want to write the order due to it involving a high risk for a negative outcome?

now this is something that any medium size hospital will have to deal with on a near daily basis.

so can you see how this regulation can cause problems, and even increase the number of incidences for a negative outcome?

everwonder_y · Mar 1, 2012

Typoagain, I'm not necessarily disputing what you're saying, but can you provide a citation about Medicare reimbursement rates being influenced by patient satisfaction surveys?

elprup, BSN, RN · Mar 2, 2012

There are over 500,000 of us on allnurses.com and why cannot these issues be solved? We need to professionally stand together and unite for better treatment of patients. All of us as Nurses!

nurse2033, MSN, RN · Mar 2, 2012

Yes, because nursing leaders are not chosen for their leadership abilities. They are chosen for their management experience, which to me means they have been hanging around the longest. I've worked in several industries and the nursing managers I've known have been, as a group, the worst. People tend to use the term "leader" and "manager" interchangeably but they are far from being the same thing. What nurses can do is support leaders that show "leadership" which requires vision, communication, and technical ability (i.e. power) to carry out the vision.

Altra, BSN, RN · Mar 2, 2012

Typoagain, I'm not necessarily disputing what you're saying, but can you provide a citation about Medicare reimbursement rates being influenced by patient satisfaction surveys?

CMS (Centers for Medicare and Medicaid - a division of the federal Dept. of Health & Human Services) surveys Medicare recipients who have been hospitalized. The actual survey tool used can be viewed here:

http://www.hcahpsonline.org/Files/HCAHPS%20V6%200%20Appendix%20A%20-%20HCAHPS%20Mail%20Survey%20Materials%20(English)%202-16-2011.pdf

The various tabs on this site explain HCAHPS pretty thoroughly, including incentive payments tied to HCAPS scores beginning in the federal fiscal year 2013, which begins October 1, 2012.

https://www.cms.gov/HospitalQualityInits/35_HospitalPremier.asp#TopOfPage

Altra, BSN, RN · Mar 2, 2012

I had a reading assignment for a class the other day on management and leadership. I read that "the problem facing healthcare organizations is that they are overmanaged and underled." Do you think this is true, and why? What can we as nurses do about this problem?

That one sentence may or may not be representative of the rest of the article that you were reading -- it's difficult to comment without knowing more about the context.

The author appears to be making a point about a difference between "managing" and "leading" ... is that relevant to what is being studied in the class right now?

newgraduate52012 · Mar 4, 2012

That is so true. I work at our local hospital as a CNA while I'm going to school to get my RN and the last two years we have really focused our care on our HCAP scores. I didn't even think about it like the way you have described above. Thank you for opening my eyes to these issues. What would you suggest to the individuals that developed HCAPs?

newgraduate52012 · Mar 4, 2012

That one sentence may or may not be representative of the rest of the article that you were reading -- it's difficult to comment without knowing more about the context.
The author appears to be making a point about a difference between "managing" and "leading" ... is that relevant to what is being studied in the class right now?

Yes, the reading was primarly about the differences between a leader and a manager. The quote itself was in a section of reading pertaining to "developing the role of leader," It then stated after the quote of "problem facing healthcare" that this is a problem were facing becuase we can teach a person to become a manager,but leaders are created over time and through experience (Yoder-Wise, 2007).