disney158

I used to work in Pittsfield MA, so I also suffered thru thse audits, not a very fun job we have, so many people to please....so many people to teach to do the right thing....uggh...I just came to work depresseed already !

I'm glad I stumbled into this thread, in Jan. 2009 NY went to case mix for reimbursement based on MDS and I can't tell you how angry I am and annoyed, at one organization I work at. What a miracle that 75% of the Medicaid patients in this facility needed some sort of restorative therapy during the capture period, and I'm talking about everthing above a RHB even up to RUB, and that remaining 25% miraculosly fell into a skilled or special care category. How lucky for that organization!!!!!:imbar:eek::angryfire Tell you what, I am mortified that I am involved in this as the MDS person, and I can not believe the OT's PT's went alng with this and did these "therapy " sessions and the Dr.'s signed the orders. Of course, the bull ****... it's good for the patient" was thrown about, give me a break, lets do RPT 5 x45 minutes for 3 weeks so it will be easier for the CNA's to transfer this mechanical lift, non-verbal severly Demented... really now, this person had no need for this therapy is no different than she was before the therapy and is no different no. EXCEPT the organization was able to get more $ by increasing the CMI... this is total and utter "rape the system" for the money, but in the end is is our $ that will be affected, all of these budget cuts are happening as I am sure many for profits are playing this game , and it is total crap.

You are so right and this whole thing is heart breaking. Now into the second attempt at the case mix upload for NYS reimbursement, I find that my MDS role seems to no longer be to get the best patient outcome but to get the best fiscial outcome. I am no longer a nurse during these "capture periods", but a number cruncher, and I am heartbroken and frustrated as I have loved doing MDs in the past and explaining how the whole process works from getting someone in the door to MDS creation to care planning for the best patient care possible, now my whole role is focused on eeking out that last little bit of 0.02 to a RUG score. The interesting thing is that in one facility I am part time and they are the ones really pushing , pushing, and in my full time job, this is not happening. Amazing how one corportion is really smart and one is really pushing the limits:banghead:

I am all in agreement with the extra $ spent for the staff to do the work, but since we are salaried, we are expected just to get the job done, so , the facility believes they will win more $ in the long run pushing the slave/salaried mds workers get the job done and hunt and peck out those RUG's, can you tell, yes I am annoyed at this practice !!! And no, they do not cange the meeting schedule nor the annaul, they are just extra quarterly's, and no , there is no policy and procedure for this.....

Yes, I have also joined that "crowd" the facility is so going for the big $" that I am doing extra Quartely's on every applicable state resident to up the score for Case Mix, ... and to top it off isn't it a miracle that these peopla are all of a sudden getting Restorative Therapy and it just happens to be during a lookback period, it's a MIRACLE.... I can not imagine that the Dept of Health?CMA?State who ever, is going to allow this... I really feel this is not right... and my stance, if it ever comes up , will be I was told to scedule and assessments, I did, I completed it correctly based on the manual, I am glad I am not the OT or PT providing the therapy, because I would really have a hard time justifying this practice, even if "everyone else is doing it", I am not putting anything false or incorrect in the MDS to bump up the score. I am actually at 2 different compainies, one is so very reasonable and doing the right thing, the other is just all for the $, and this is horrible. AT this "other organization" I am no longer doing MDS to improve the lives of my patients, I am now completing MDS for a "for profit organization" to gleam every last penny, even if it takes me hours to get that PC1 to be a PC2 and have the RUG score jump up by .02... and it makes me sick.....and heartbroken, I did not become an RN to do this....

That is my take on the subjecct, and thank god ,

I really feel comfortable that when I sign on R2B I sign that the MDs is complete, not that it is correect, I will not sign for the sections that I feel are inerror, as I said, I am siging R2B, and the way I read it , that is only indicating the MDs is complete, this particular orgainization has been purchsed by a new owner and the $ stretching is not going away...here in NYS, the reimbursement has also changed for MEdicaid from a PRI to the MDs, and now at this particular place, we have lived thru inservices oto the CNA's on how to "document", of course the push is to document the maximum assistnace the cna gave at all times, once again, not illegal, just shy of it in my words, but all of the administrative people, feel this is totally appropriate and within all of CMS guidelines, we were just never getting paid the "right" way for all of our hard work before, so if a CNA provided hands on 1 time in an ADL activity, they are being told to put down assist of 1 for any minute weight bearing act, and even for those folks who eat, in the main dinning room, there is a nurse in there for all meals, just in case they are needed, and the folks are served resturant style, everyone is being ut down at least for supervision in eating, even if they are independent walkie talkies and can go into a returant and order a meal, becuase they are being "supervised" ...once again, I am arguing they are supervised because that is how we wet up the dining experinece, not becuase it is needed, HELP ME !!! So frustrated I can not spell right

"they are recieving PT and OT, and they are only cut form OT, you must give a cut letter for the OT when it is cut. This is a new rule, and there is a special form for this." VeryBerryRn, can you site where this came from, and the special form I am stupid and can not find it on the Web, thaks so much !! Nadine

Update : Did I also say that I also put in for the grant for my part time job at another SNF , and also GOT THE GRANT THERE TOO ! So, I have obtained almost $80,00 for 2 SNF"S which is more than my salary ! That facility has sent me a huge flower arrangement and is writting press releases thaking me, at the FT facility I first posted about a big fat NOTHING !!! We even have a new DON and the adminsitrator mentioned the grant we recieved at a morning meeting, the DON asked who worked on the grant and the administrator said, " I did", so now there have been 3 emails and multiple verbal accounts by the administrator staing "he worked" on the grant, with absoultely no acknowledgment for me. That was it and I went to Human resources for support, confidentially and it was suggested I speak with the administrator. The administrator is stopping by my office today to discuss this, and I am tyring hard, really hard to keep my composure... I have already cried multi[ple times, and have all of the documentation in a binder of all the work I did and all the work back and foth between my self and vendors. It will be impossible for the administrator to indicate he did the grant alone, also in my orgininal and subsequent versions of the grant paperowrk, I was to be the administrator of the grant, I guess that must have changed too... oh well, I feel sick... will continue to up date as I greatly appreicate the support, I hav never been here before... Nadine

Thanks to all, this happened yesterday and I am waiting as I am too angry/hurt/annoyed to approach this topic with him. He is the administrator, young ( middle 30's been in the field for about 10 years, 2nd administrator role), very upwardly mobile with high asperations... I can't tell you how many weeks, hours, went into that thing, specific language , no more than 1 page to define what was asked for, specific page limits for specific parts, it went on and on , then the pieces of the grant would be assigned points to see how correctly you responded , the points were addedd up and those with the most points recieved the grant. I worked on it at home, called venders, suppliers, searched for the best pricing, agonized over the verbiage, and then handed it over for "tweaking". Let me tell you, I feel 'tweaked" :angryfire This was also done while I was doing all the MDS "stuff" for a 82 bed SNF with 25 Subacute beds that are always filled, and chairing all the care plan meetings, the chair of the Falls Comittee, on and on ...I am so sad , but do not want to dig my own grave by angering my adminsistrator, he has all the power...but I can not go on like this, I feel like a volcano with the lava brewing.... all of your suggestions were great, I will wait a week until I go back to basline and then approach with ...can I help in the delivery of the grant and can I have something to put into my personnel file that reflected the work I did on the grant..., and I will add it to my resume... but still.... in this tight fiscal hospital/snf enviornment, recognition from upper level management would have been , in my eyes, appropriate... so is almost $50,000 nothing to speak about ?

I don't mean to sound ******, but, I told my supervisor about the opportunity of a grant for the facility, I worked on the grant paperwork endlessley for a month, took it home, aganoized over it , etc. Since it was the first grant I have ever tried for, my supervisor, the administrator, helped, "teaked" it, improved portions of it, and then sent it to the facilities "grant writting team" for further enhancements. I worked on it for weeks, hours, besides completing my regular work. He just heard yesteday that we recievd the $40,000 grant, we are a 80 bed SNF in a 300 bed community hospital. My issue, I was the one who found and researched the grant, brought the ideas to my supervisor, created the pages and pages of documentation, called for pricing, etc on and on. I found out thAt we recieved the grant when a general memo was sent out yesterday by my supervisor, thanking all who worked on the grant. I was not individually mentioned, even though, only he and I , besides the tweaking by the grant team, where the only ones who worked on it.. I am so beside myself and angered...:angryfire I took that grant home, slaved over it and am getting no recognition... My husband tells me I have become Melanie Griffith in "Working Girl" and the administrator is Sojurney Weaver ( workng spelling, but you get my meaning). Help me handle this please....how do I professionally indicate my frustration, or do I ?

Prioritize, delegate,...."any problems can be blamed on your predecessor?" ... I am perfectly okay with this statement, most times it is true... but fix those problems, first.. make a difference for positive change and you will be respected and worked with. it is not whiney or finding an excuse, as long a it is the truth. What a terrifying idea to be placed in the dual role you have, we know MDs is time driven, and now you have the gift of an addittional job that will swallow up all of your time like a black hole. My two cents, MDS goes to Unit Mangers or RN's with a weekly "come to Jesus meeting" with you, face to face, to be sure they are finished correctly and timely, you can do a quick check of sections that count the most, those for QI/QA and reimbursement, and that part is taken care of. The best DON's I know are those that empower their staff, appear to be incontrol and calm, and are approacheable by staff. They also delegate, and review what has been delegated, give specific time frames with specific expectations and then reward when complete, even a simple email , "thank you for a job well done and timely, I apprciate your work" goes a really a long way. Don't micro manage and think you must do everything.. good luck.....

"before cell phones, IMO, there werent as many "emergencies" and if there were emergencies...they were made and recvd from the company phone" :yeah:I am so glad so many people think like I do ! I started the thread, and still am constantly embarrassed by having to speak with family members about the staff with the blue tooth device... you can't imaginine how indignent the CNA's get with me... ie: " my babies come first before the job".. can I say to this person,.... "well then you don't have the right job and I am willing to take the job back from you...try Walmarts or McDonalds" ... it has been getting to the point that when I see a staff member..peer RN, CNA, LPN, Tech, buzzing, beeping or ringing during a meeting, inservice or speaking with family's/patients ... my whole outlook and facial expression changes, my faces turns red..I can't help it , it is now an autonomic reflex, and god help the person if they check the phone... I can just not imagine being so rude to think the employee is "entitled" to this behavior, the patient is not even a thought in their head...

You do have manners and I carry a cell too, but can you believe someone would do this to a resident. And to top it all off , to get natsy to me when I told her not to use the Bluetooth ever on the floor, can you imagine what they can do to already confused residents, arent' the residnets to be the focus of care, that wouldn't even be tolerated at Walmarts.... which is where I wanted to suggest she go work, but I held back..

I just remembered, is it Bluetooth ?