I feel like we are rapidly reaching jump ship level. My own sister (in her 40s with 4 kids and natural born Texas/US citizen) is actively migrating her family to Canada next year. Her daughter with a clef pallet cost her family 90K last year WITH insurance. Her husband makes $150K a year, so they managed...but Christ! My sister is so serious that she already submitted all her immigration papers and is waiting to hear back.
I work in a clinic. The ER at the hospital I work for has sent critical patients to our clinic because they 1) apparently have no staff that know how to evaluate for a emergency (I say this having 8 years ER experience under my belt). I had a patient go to the ER twice in 24 hours for urinary pain, bleeding 1 week post op. They sent him to the clinic pale AF, orthostatic blood pressure 80/40, bladder scan showed 330 after voiding (ended up being a giant number of clots that I got to try to hand irrigate in the OFFICE!). The ER did a UA at both visits and NOTHING ELSE.
You might want to say this is my institution in particular...however I haven't held a job at 1 institution for more than 3 years. I've traveled. So, yes, there are better and worse.....but they are ALL getting worse. Process improvement usually involve trying to make up care gaps with unlicensed, under educated, unqualified people OR have one qualified person do the work of 3-4 people (both of which create gross care gaps).
I wish I could go with my sister. This has only gotten worse in the 15 years I've been a nurse. I'm not proud of my field.
My understanding is that the litigation has occurred due to various facilities' interpretation of the standard of care required in the emergency dept. setting. As I understand it, the outcome of those cases affects what is defined to be the appropriate standard of care in the emergency dept. Also, as far as I know, the threshold for inpatient admission for Medicare is that the patient requires medical/nursing care for an acute illness that cannot be treated at home and for which the patient is likely to deteriorate/would be expected to deteriorate if they are not admitted as an inpatient.
I am correcting the above bolded to say anacute medical problem instead.
Medical devices contribute to our unsustainable health costs. Insurers benefit from pushing patients out of the hospital nursing units and into outpatient care, they lobby for that power.
Simply review health outcomes to understand that fancy and expensive new devices are not improving our overall health or improving our outcomes. They are a profit generating endeavor.
I do not disagree with you that medical devices contribute to unsustainable health costs but that is sort of contrary to Spiker's position that patients in the U.S. are denied the latest implants. New things cost more than old things. You control costs by continuing to use old things. If you do not want to use expensive new technology, then don't.
I would recommend reading those two articles I posted up, it is not the insurance companies, or at least not them primarily, who are driving lower LOS in hospitals. That was a core objective of the PPS system.
"Promoters of the policy hoped that payment reductions would be matched by lower levels of spending through reduced lengths of stay (LOS), reduced intensity of care, and more efficient hospital operations. Promoters presumed this could occur without financial collapse or compromises in patient care, as large volumes of "slack" were used up (unproductive resources reallocated, unnecessary ancillaries and days eliminated, and so on). So long as hospitals had been reimbursed their costs, they faced few incentives to provide efficient care. PPS gave hospitals new incentives to operate economically."
Specializes in NICU, PICU, Transport, L&D, Hospice.
Asystole RN said:
The assumption you make is that in other markets, like lets say Europe or Canada, that their patients are receiving that better implant, repair method, fixation method, etc. I think the difference here in the U.S. is that the more expensive options are just that, options, whereas in many places the basic option is the only option.
I work in medical devices and have friends who work for companies like Stryker in Europe. For the most part, new fancy devices are launched in the U.S. years before they are even considered to be launched in places like Europe or Canada. When they are launched they are typically only available at the private hospitals and/or are available to those patients with insurance.
P.S.
It isn't insurance pushing patients out of the door, it is the federal government. One of the whole points to moving to a DRG based system by the federal government was to encourage hospitals to push patients out of the door.
DRG is a tool used in many countries to manage healthcare monies. DRGs are not our problem. Our fractured health system is broken by the capitalist motivations.
I do not disagree with you that medical devices contribute to unsustainable health costs but that is sort of contrary to Spiker's position that patients in the U.S. are denied the latest implants. New things cost more than old things. You control costs by continuing to use old things. If you do not want to use expensive new technology, then don't.
I would recommend reading those two articles I posted up, it is not the insurance companies, or at least not them primarily, who are driving lower LOS in hospitals. That was a core objective of the PPS system.
"Promoters of the policy hoped that payment reductions would be matched by lower levels of spending through reduced lengths of stay (LOS), reduced intensity of care, and more efficient hospital operations. Promoters presumed this could occur without financial collapse or compromises in patient care, as large volumes of "slack" were used up (unproductive resources reallocated, unnecessary ancillaries and days eliminated, and so on). So long as hospitals had been reimbursed their costs, they faced few incentives to provide efficient care. PPS gave hospitals new incentives to operate economically."
I don't know how anyone could think a policy of decreasing LOS belongs in the same sentence as reduced intensity of care.
How can the current system work? Plenty of us spent hundreds of thousands of dollars on school, just to make subpar wages. The healthcare we receive is a joke. To top it off, it's a really unforgiving field as far as making a mistake or taking your mental health seriously. The motto is: work yourself to death, throw away your health and wellness, and we will kick you when you've reached your lowest point. I think we're all too far in it now to turn around. If I could do things over again I don't think I would have embarked on this career. And that's sad. Because there was a day I actually loved it.
Specializes in Surgical Specialty Clinic - Ambulatory Care.
vintagegal said:
How can the current system work? Plenty of us spent hundreds of thousands of dollars on school, just to make subpar wages. The healthcare we receive is a joke. To top it off, it's a really unforgiving field as far as making a mistake or taking your mental health seriously. The motto is: work yourself to death, throw away your health and wellness, and we will kick you when you've reached your lowest point. I think we're all too far in it now to turn around. If I could do things over again I don't think I would have embarked on this career. And that's sad. Because there was a day I actually loved it.
Yep, there hasn't been a day of work since my first year that I haven't wished I had chosen a different path. I didn't hate what I was told nursing was, but what it IS doesn't even come close to what I expected. Like I am at a point where I will not pay for my daughter's college if she chooses a public service field. That way when she see the expectation is for us to give ourselves to death merely for the greater good WITHOUT being able to have the basic connections in life that make it WORTH sacrificing yourself some for....she can quit and I'll pay for her next degree. I remember in my teens having such respect for teachers, healthcare professionals, officers...I still respect them for the sacrifice; I just now think they are stupid for doing so, myself included.
Yep, there hasn't been a day of work since my first year that I haven't wished I had chosen a different path. I didn't hate what I was told nursing was, but what it IS doesn't even come close to what I expected. Like I am at a point where I will not pay for my daughter's college if she chooses a public service field. That way when she see the expectation is for us to give ourselves to death merely for the greater good WITHOUT being able to have the basic connections in life that make it WORTH sacrificing yourself some for....she can quit and I'll pay for her next degree. I remember in my teens having such respect for teachers, healthcare professionals, officers...I still respect them for the sacrifice; I just now think they are stupid for doing so, myself included.
Fortunately everyone is not as cynical as you. There are other awful circumstances in many other jobs, not just healthcare. But the downward spiral has been abrupt and we need to do things differently. But I think the fires will catch up with us soon.
Not so sudden. Many sources I've read trace current ills back as far as 1973 when for-profit health insurance became legal. I graduated and was licensed in 1972, so I've had a bedside view since the beginning. Very glad I'm out.
Specializes in Mental Health, Gerontology, Palliative.
Hoosier_RN said:
So many jump on the socialized medicine bandwagon. Wait lists are a norm, as they are here and in Canada, and other countries.
the American system is stuffed. People should not be denied needed healthcare based on bureaucrats with algorithms. I've used this example before, had a 7 day stay in hospital for an infected axillary abcess. The whole cost for the seven day stay including surgery, discharge meds, and follow up wound care? $15 for the Dx prescriptions.
Quote
My cousin is a nurse in a German hospital. She says there are shortages of so many things, staff and supplies.
Our system is far from perfect I can be reassured that if I end up in an accident with life threatening injuries the cost of my hospital stay, any surgery post op rehab and income support (80% of my preinjury wage) will be covered.
If I get diagnosed with a serious illness, treatment is also covered.
In the last few years I've seen a few cases of people with a serious illness that have gone to the US for treatment. However thats because the medical tech is not avaliable elsewhere and it cost them hundreds of thousands. T
hey didn't go because America has a superior health care system. If they could have gotten the needed medical treatment in subsaharan africa they would have gone there
Specializes in Surgical Specialty Clinic - Ambulatory Care.
subee said:
Fortunately everyone is not as cynical as you. There are other awful circumstances in many other jobs, not just healthcare. But the downward spiral has been abrupt and we need to do things differently. But I think the fires will catch up with us soon.
My opinion on my cynicism is that I am to young to have known our healthcare system as a worker at it's peak, but young enough to remember what good care felt like. Young enough to see that it is missing and getting worse no matter how much effort my very hard working colleagues or I sacrifice. In the trenches long enough to know that we (nurses, CNAs, doctors, etc.) for the most part honestly don't come to work 'just for a paycheck'. That the dedication is still there, but the old rhetoric isn't working. The for the greater good is dying because we see it for the lie it is. We aren't busting *** for the greater good. We are busting *** to deepen the pockets of people we will never meet. The people who put dollars before better outcomes, employee health, and functional work environments. I don't think of it a cynicism anymore. It is realism others don't want to accept. I think nursing means so much to someone like you because your career was good. Headway was being made way through hard work and dedication. And somewhere around the 1970's (along with the American Middle Class) it slowly started dwindling. I was born in the early 1980s. Healthcare and the middle class have been slowly dying since I was a kid....and I can tell the difference. The only way to being it back is a mass influx of Unions in healthcare (and all jobs for that matter), and for us to have some sense of duty through a nationwide healthcare plan. Like roads and bridges, without some key accessible healthcare to large swaths of people, we will crumble.
We are no loner at "ask what you can do for your country"? The people gave the US dedicated loyal workers and what happened was we let capitalism talk us into perverting every endeavor into ponsi scheme. Now is the time to ask, "what can my country do for me.....because I may need to take my expertise elsewhere to give my children a better life".
Specializes in Surgical Specialty Clinic - Ambulatory Care.
Tenebrae said:
the American system is stuffed. People should not be denied needed healthcare based on bureaucrats with algorithms. I've used this example before, had a 7 day stay in hospital for an infected axillary abcess. The whole cost for the seven day stay including surgery, discharge meds, and follow up wound care? $15 for the Dx prescriptions.
Our system is far from perfect I can be reassured that if I end up in an accident with life threatening injuries the cost of my hospital stay, any surgery post op rehab and income support (80% of my preinjury wage) will be covered.
If I get diagnosed with a serious illness, treatment is also covered.
In the last few years I've seen a few cases of people with a serious illness that have gone to the US for treatment. However thats because the medical tech is not avaliable elsewhere and it cost them hundreds of thousands. T
hey didn't go because America has a superior health care system. If they could have gotten the needed medical treatment in subsaharan africa they would have gone there
I just think it is sooooo funny people are always listing long wait lists as a national healthcare coverage negative like we don't have them here in the US capitalist care system. I work for a surgical specialty clinic. We currently are scheduling screening colonoscopies 8-10 weeks out, vasectomies 8 weeks, cystoscopes 10 weeks, laparoscopic galbladder removals 6 - 8 weeks. We are already wating.
Susie2310
2,121 Posts
I am correcting the above bolded to say an acute medical problem instead.