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Saturday, November 2, 2013

DR. Creed: Updated for Obamacare

The following is an email intercepted discreetly by Doctor Ven Tolin, President Dr. Creed Association.  It was sent to Carl Breatheright, CEO Shoreline Medical Center:

Here is the information you requested in our last email. 

Obviously we don't expect you to read the bill (legislatures did not either).  Below are excerpts of the sections most pertaining to the respiratory therapy department.

Updated DR. Creed for Obamacare; January 12, 2013; legal legislation per codus 2.2343 of the respiratorium interstitium, page 3,432 of Obamacare legislation; line 72; section 3; article 3,432 (right after the "it's not a tax" section)

A patient admitted to the emergency room with vague complaints should be treated as Genericus Patientus, and order sets must be instigated to toss at these patients.  All hospitals must treat every patient the same.  

For example:

Sepsis Order Set:  Criteria for order set is two of any of the following: 
  • Respiratory Rate (RR) greater than 21
  • Heart Rate (HR) greater than 90
  • Temperature greater than 102.5 degreed F. 
In order to meet admission criteria and reimbursement criteria, all of the following must be completed in the emergency department (results do not matter for criteria purposes):
  • IV, CBS, ABG, EKG, Lactic Acid, cultures must be ordered in emergency room
  • The patient may often present as a Genericus Patientus.
  • Therapy not reimbursible of HR 90 or RR 20
Pneumonia Order Set: Criteria for order set is two of any of the following:
  • Infiltrates on x-ray that the doctor thinks might be pneumonia 
  • Normal x-ray and labs, but patient doesn't meet criteria by other diagnosis (faux pneumonia)
In order to meet admission criteria and reimbursement criteria, all of the following must be completed in the emergency department (regardless of need):
  • IV, X-ray, EKG, CBC, Chemistry, Duoneb now and then Q1 hour Duoneb or Duoneb followed by Q20 minutes x3 Albuterol
  • Sputum must be obtained and sent to laboratory
  • SpO2 on room air and 2lpm (no matter what the SpO2 is and even if patient on home oxygen)
In order to meet reimbursement criteria, the patient must be sick enough to need at least 2 of the following
  • Albuterol, Duoneb, or Xopenex Q4-6 Around the Clock for 2 days
  • IV at all times (may at a minimum run normal saling)
  • Patients with a CO2 of greater than 45 must be trialed on BiPAP (patient may refuse, but you cannot tell them that. We want patient to feel as uncomfortable as possible during visit as an incentive not to waste government time and money in the future
  • Upon discharge, pt must be instructed on smoking cessation (especially if they don't smoke), given pneumonia and flu vaccine (mandatory), and be read the first three chapters of Obamacare for Dummies. 

Job openings. rt cave. qualifications: Must have an associates from an accredited respiratory therapy school, with registration and license.  Must possess the skill of patience and the ability to not use the skills obtained while in school, and must be able and willing to do as told, push buttons, and pass nebs. Must possess ability to regress urge to punch doctors for writing stupid doctor orders and following stupid order sets. 

I found that last one interesting, which is why I added it in this email.  Even the author of Obamacare regards the RT department as the most likely to fight any changes forced by Uncle Sam.  We must continue to keep RTs apathetic and burned out with "stupid doctor orders" (lol) to keep them in check.  So far it seems to be working.  The last significant punishment to RTs was when we made DRGs legal, and made it so RT therapies are non reimbursable. We figured that would get rid of them, but somehow they continue to linger.  

Dr. Sloof Lirpa
Medical Director of Obamacare Enforcement Committee
Washington D.C.
Shadow Government Committee # 332353
email shielded by code #352342344
illegal access punishable by HR Bill 773432 and may involve participation at all C-sections and deliveries

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