adlockwood

50 pounds in 90 days is unrealistic and a set up for failure. I joined Medical Weight Loss Clinic and work out with Jillian Michaels DVDs 4-5 days a week and have lost 36 pounds in almost 7 months. That is a healthy average of 5 pounds a month of consistent weight loss with 14 more to go. I have gone from size 16 to a size 10-12. It is about 1350 calories a day with higher protein and unprocessed foods. Rapid loss causes a rebound effect that is very demoralizing. Workouts made all the difference and it must be forever. By the way, I am 57, was pre-diabetic and overweight for 20 years. If you wear off the fat, and exercise, the insulin resistance problem goes away.

Hear hear! It is about time someone talked about boundaries. You have a right to a break. As a professional, you do what needs to be done but stop whining about it. If you are unhappy in your current role, MOVE ON! Your co-workers will appreciate it, believe me. A bad attitude is contagious I have been a nurse for 34 years, and held at least a dozen roles that taught me something in every one. I work very hard, but I feel honored to be where I am now.

The liability insurance is the same as your malpractice insurance - it is cheaper for case managers because you are not hands on. Get it thru Nurse Service Organization

Which is exactly why it is impossible to send someone to rehab who needs 6 weeks of Mycofungin at $15,000 - so they sit in a hospital bored to death and killing our LOS, and risking hospital acquired pneumonia. Let's face it - acute care hospitals are not rehab, it seems there are no alternatives for a medicare patient.

I don't mind sending my resume to anyone who is interested - unless you plan on ripping it:) Annette By the way, Tampa - I don't think you have much to worry about with that background - it is similar to mine. I was out of CM for 15 years, and my UM from BCBS was back in 1985, and they still liked it. Some things don't really change much.

I followed up on this today, and it turns out our onc case managers do this frequently and unless the chemo drug is a carve out and billed by rehab in spite of the patient already having it, it's not fraud. Besides, it's not us comitting fraud, it would be the rehab. So, my initial instincts were correct when I questioned the premise that it was fraud in the first place.

I appreciate your answers - there is always new twists and situations to learn in the world of medicine, insurance and money!

You should write a letter to your manager and let them know of your change of position and end date. You can mail it if you don't want to make a special trip in. Email is not really a classy way to quit.

For the sake of further discussion, I assume the facility doesn't want the patient NOT because he needs the medication, but because they don't want to have the cost in their case mix. My assumption is that SARs have a set reimbursement based on diagnosis, and they avoid the costly patients. Of course the fact the patient has cancer would not be hidden, but if Medicare is billed for an outpatient med, doesn't this save the SAR from bearing it? This is not my case, and as an inpt planner, this is a serious issue if a patient needs rehab but we can't place them unless the Dr stops his medication. We often have pt's on chemo incidental to the reason for admission. I am reasonably new to inpt case management and finding ways to get folks on to the next level of care is full of barriers. Chemo shouldn't be one of them (it may just be palliative chemo) and sometimes they can't go straight home.

It is an oral med, not IV, and it is still prescribed by a Dr. So, I would like to know exactly WHY it is fraud.

I posted on the case management forum, but thought maybe someone here would know. If you know a sub acute rehab will not take a patient on an expensive chemo drug, is it fraud to have the patient fill the script on the way to rehab through a pharmacy, and treat it like a home med? Some of our inpt case managers think it is, but I can't see how it would be, and may be the only alternative if the patient needs placement and is being turned down due to expensive meds.

I have worked in all of it - from floor nursing to Blue Cross, to Insurance CM, to home care, and now inpatient CM. I agree with those that vote for home care, or if you could get in to a medical home primary care provider office, that would be great. Inpatient CM is the most exhausting and unsatisfactory form of nursing in my opinion. I needed the job, but I really have to say being free and on the road was much better = whether that is home care or for outside CM.

If you send your email address to me, I will forward you a copy of my resume. Forget about my educational background, because that is not a key issue - but do look at the way I describe my experience. I did work on key words when I wrote this for my last job, which I identified by doing some research in to the job descriptions of the jobs I wanted. Make sure you mention allnurses in your subject line in your email Annette Lockwood [email protected]

One of our staff wants to know if it is considered fraud to send a patient to a facility with a script for an expensive chemo drug to fill himself through Medicare and bring it to the facility as a home med, knowing that the sub acute rehab would not accept him if they had to pay for the med themselves as part of a capitated payment?

I was out of nursing completely for over 8 years, and here is how I got back in: I started working for a home care company that was not certified and needed an RN for supervising the aides and setting up medications for the elderly in their homes. Through that, I found an additional job working part time at a day center in mental health, because several of the home care clients were also in the community mental health program. I needed full time, so I got a job as a hospital based case manager, but after 6 months, I am high tailing it back to mental health now that they have a full time opening combining my old job with part time at the mental health clinic. Hospital work is nuts, plus our facility is starting to add weekend and holiday rotations too for the case managers. One thing about being out of it for a while - I don't want to go back to working 7 days a week! And why for the love of Pete would you need a case manager on Christmas Day???? I don't even care about the money - I need a life