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Friday, April 15, 2011

Hospitals, Doctors Blackmailed by the Government

We have to face the facts, fellow RTs, that one of the main reason we are doing so many non--indicated procedures, and our morale diminished, is because the government is blackmailing hospitals and doctors.

You heard that right. Hospitals are being told by CMS they have a choice whether they want to do something, yet if they don't do it they will not make as much money. Hospitals and doctors, in essence, are being blackmailed.

A perfect example of this is the smoking cessation program. Chances are your hospital board has discussed the smoking cessation program. The choice is this: You do a smoking cessation on a patient you get reimbursed more for that patient, and if you don't do it you get reimbursed less

In my opinion this is not a choice. It's more of a nudge. If you don't do the smoking cessation on a patient, the hospital will get paid less. So the hospital is basically forced to do it. This is blackmail.

CMS actually says it's a choice to make it look good to us, because most of us Americans love to have choices. Yet a true choice would be one of many options, including the option to do nothing. You also have an option to be smart and an option to be stupid. You should not be punished if you decide to be stupid.

So instead of choosing to use common sense, many hospitals are doing smoking cessations on every patient just to cover their bases. This means that even if you don't smoke you will be educated.

Now this isn't so bad, as even people who say they quit smoking are still hanging around people who do smoke. These new ex-smokers are not aware second hand smoke is bad for them. Believe it or not, there still are uneducated people like that. So education on our part is good.

Yet we RTs don't necessarily have time to do smoking cessation on every patient. We barely have time to do the ones that are needed, yet we certainly don't have time to do them on every patient. We are overwhelmed already as it is due to all the order sets and lack of RT Driven protocols at most hospitals.

So you can see how the blackmailing of hospitals to do smoking cessation programs has unintended consequences. It results in burnout and apathy of workers. Yet Administrators don't care so much because in any business, the bottom line is that we get reimbursed, or that we make money.

Another good example is the so called "death panels" as passed by the Obamacare legislation. The death panels really aren't death panels, but they do create a script doctors must follow with each of their patients about discussing end of life care.

Now, a part of me likes this. I think all doctors should discuss with patients what they would want at the end of their life if they are unable to make decisions. If a person has terminal cancer, do you want CPR done on you, and do you want to be kept alive on a ventilator.

I think this is good. And I also it should be up to the doctor to discuss this with a patient. So this is what Obamacare does: it gives doctors a choice. The choice is this: You do end of life care and you get reimbursed for that patient visit. If you don't do end of life care, you still get reimbursed, but you make less money.

So what doctor in his right mind will not do end of life care, and use the government script. In this way, CMS is nudging the doctor to do what an expert sitting in an office in Washington believes is idea. It's blackmail.

Is this choice? Yes! Is it a good choice? No really. It's a nudge. It's forcing us to do it your way. It's blackmail.

A government script is an attempt to convince people that death is imminent and we shouldn't be spending money on you, then the death panel discussion is valid. Now end of life counseling is good, and it should be done on all patients, yet it should not be a mandate by the government.

Likewise, it allows doctors to decide if a 90 year old lady should get a hip replacement, or 100 year old lady a hearing aide. The patient and the family should be deciding if the cost is worth it, not Uncle Sam.

It will, in essence, become nothing more than a screening program to cut out the most expensive years of your grandma's life. It will save the government millions of dollars per year, if not billions. To the government, it's all about saving money. To hospitals, whether they agree with this blackmail or not, it's all about making as much money as they can. So they have no choice but to "COOPERATE!"

One concerned mother asked a famous person in Washington about whether Obamacar would pay for her 100 year old mother to get a hearing aide she wants so bad. The politician answered, "No, no, we gotta start talking quality of life, too, we can't calculate spirit and how much she wants to live. Give her a pill. People like that we should just give 'em a pill."

He later said, "I don't think we can make judgements based on people's spirits." If you are terminally ill, or if you have a bad heart, or if you have the beginnings of a disease like Altzeimers or Parkinsons, your doctor will, by law, have to encourage you to not seek any procedures that will prolong your life.

That means no expensive CPR or breathing machines. That means no expensive life saving medicine. That also means no hip replacements. No nursing homes. No hearing aides. No pacemaker.

Some people, even at 105, have a certain spirit, a certain joy of life, a certain love of live, a high quality of life and they want to do whatever they can to live another day. These people should be able to get the hip replacement, the hearing aide, the pacemaker or whatever.

Will a government in Washington be able to see this spirit, this joy, this quality of life. Or will that government official, that government expert, only see her as a 105 year old burden on society who will die anyway soon so let's not waste our time or money on her.

That government expert will see it as a government shut off at some age, perhaps 75, or 65, or if the cost of healthcare becomes too much of a burden, perhaps even 55 or how about 45? Where does it stop?

Will my mother have to go to the government to get a procedure done? What if it's a lifesaving procedure? By the time the government has an answer it may be too late anyway. This kind of thinking sends chills down my spine. This is America not Cuba.

Since the government's flipping the bill, This sounds Orson Wellish, 1984 type stuff. I never in a million years could have imagined we'd be having this discussion in America.

Now you might say, "well, it's not a mandate." But it is. When the government tells you you won't get paid if you don't do it, then doctors who accept Medicare will have no choice but to do it. Thus, it's mandatory. Either that, or it's blackmail.

Granted, this is not an opinion, it's fact.

What do you think?


1 comment:

Anonymous said...

Live by the sword, die by the sword. Blackmail your patients, then you shall be blackmailed also.
Is there anyone awake out there?