Why is healthcare a such mess? How can it be fixed?

Your Question:  The healthcare system is a mess.  How did it get this way? What is the solution?

My Answer:  Let me start by saying that in front of me right now is a bill from Paula Sterns Hospital in Ludington, Michigan, from March of 1943.  It is the bill for my grandma's entire three day stay when she had my dad.  The cost was $23.00.  The ambulance bill was $2.  If you adjust these bills for inflation, they come to $317.26 and $27.59.

The cost of just one breathing treatment today is $123.00, so you can easily see that something occurred in healthcare that inflated the cost of it by a stunningly high margin way over the rate of inflation.  What happened was that, during the 1960s, the progressives decided that the healthcare system was messed up and they could fix it. So they created regulations. So now hospitals have to hire people to make sure the regulations are met.  To pay these people the cost of healthcare increases.

In the 1970s they realized that the prices were too high for many people, so they had to come up with another solution. This time they created medicare and medicaid and DRGs and more regulations.  To make sure regulations are met, more people must be hired.  To cover the cost, prices go up.  But now people still can't pay, so third party system is created.  So now the hospital bill does not come directly from the hospital at all, but from insurance companies.  So not only do you have to pay the hospital bill, now you have to pay an insurance bill as well.

So this is the system until 2010.  Now you have healthcare prices that have skyrocketed beyond belief. You have 40 million people who have no insurance at all, some by choice and some not by choice.  You have the same people who messed up the system in the first place try to fix the problem, once again, with more government.  More regulations are created.  Hospitals now have to hire hundreds more personnel just to make sure regulations are met.  This is done at the expense of patient care, even though it is meant to improve patient care.  Instead of prices dropping, they skyrocket once again.

So who is going to solve the problem now.  Hopefully not the government.  The government got involved in healthcare during the 1960 and created the same problems they propose to fix.  And the more they try to fix it with their ideal solutions the more they make it worse.  They do not ever solve the problems they propose to fix, they only succeed at creating chaos.

The solution to all of this is simple: let capitalism work.  That's the only thing that has not been tried, at least since the 1960s.  When you go to the hospital to seek a service, you should get a bill from the hospital for that service.  The price would not include any middlemen, and therefore would be very inexpensive, like it was in 1943 when my grandma only paid $25 for an entire hospital stay.

Surely the price would be a little higher due to inflation and technology, but price of healthcare today is beyond reasonable.  Why? Because, back in the 1960s, government officials, sitting around a table in leather chairs drinking coffee, decided they could make it better.  Did they? Absolutely not.  These people need to get out of the healthcare industry, and let the people, the markets, the states, solve the healthcare crisis.

The real solution is capitalism. Here you would have individual hospitals compete for your services.  What one hospital did best to win you over, other hospitals would copy.  When one hospital creates a program that fails, other hospitals will not copy that program. That is what's needed. Competition is the best method of driving down prices.  If you charge too much, people can go somewhere else.  If you provide good service at a good price, then your hospital will be the one chosen.

I am not naive.  I understand there are outside forces involved in price increases.  There is better technology today, there is better education that costs more, etc.  But, still, the healthcare solutions since the 1960s have all come from Washington, and everyone of them has failed to solve the problem.  And so many people say, "Well, what else can we try?"  I propose to try capitalism, because it is the only solution that has yet to be tried -- at least not since 1943.

What do you think of Obamacare?

The Patient Protection and Affordable Care Act (PPACA), a.k.a. Obamacare, has forced upon hospitals a new program that will punish hospitals as far as reimbursement is concerned for any COPD patient who is readmitted within a two week period of being discharged. This does not include emergency room visits, only hospital admissions. 

This provision of the law was made with the idea of giving hospitals an incentive to pay special attention to their COPD patients to make sure they are educated about their disease, are on all the best medicines, and their are follow up appointments made to make sure the patient is taking his or her medicine. 

Other people disagree with that claim. They say that the provision was implicitly placed into the law to give CMS an excuse not to reimburse hospitals for said patient.  There is some credibility to their claim considering it does not matter what the patient is readmitted for: heart failure, COPD exacerbation, high blood pressure, low blood pressure, rickets, a hand nail, or anxiety.

These patients have a high rate of morbidity, and it's nearly impossible to know, even if the physician is being proactive, what ailment might plague that patient in a day or two.  Our hospital, and every other hospital I've ever worked for, has had a steady flow of COPD patients, many who are admitted often enough to become good friends with the hospital staff.  With this law, there are many hospitals that will go under. 

There is also a stipulation in Obamacare to make it easier for hospitals to merge, and many hospitals in the geographical region where I live have merged since Obamacare went into effect.  Some of my friends claim that these provisions, and the entire Obamacare law, was implicitly put into place with the intention of causing the health care system to fail.  When the health care system fails, people will come calling to the government to bail them out with universal health care. 

With most hospitals already joined into large conglomerates, taking away competition and the incentive to lower prices, the government will have fewer companies to combine.  When Obamacare fails, they say, so too will the health care system. 

I think it was worded best by a physician friend of mine:  "The government caused the mess with health care by becoming involved in it in the 1960s, before that time it was a pay for service system, and the cost of health care was low.  Since the 1960s, health care costs have increased, making it so most people cannot afford it.  So then career politicians, the same people who caused the problem, purported to fix it with even more government. This is a system set up for disaster." 

I personally, as my regular readers already know, am among the 54-58% of Americans opposed to Obamacare.  What do you think of it?  Be nice. 

The current state of healthcare

So the patient was sitting on the edge of the bed, leaning on a pillow to breathe.  She was diaphoretic and extremely dyspneic.  She was rhales all the way to the tip of her voice box, and she was moaning in agony, "Please just shoot me!  Please, just put me out of my misery!"

The RT said, "I cannot do that."

The QA analysts said, "Such therapy is not covered by CMS, nor is it covered under Obamacare.  Although Obama would probably like it because it would reduce the cost of healthcare."

Hence is the state of medicine. 

Forty-five minutes after the page the doctor responded to the call.  In the meantime, the patient suffered.  The RT stood by the patient's side wishing he had the power to treat the patient. 

Thankfully, however, some things get better.  The market has forced many hospitals to hire hospitalists, who respond to patient's in need, as opposed to treating patients over the phone.  Those in Washington will, however, continue to treat patients from the comfort of their leather chairs, sometimes thousands of miles, and sometimes thousands of hours prior to the time the patient even gets sick.

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Changes due to Obamacare will collapse healthcare system????

The following is a guest post by our friend Will Lessons. I asked him to write his opinion about a recent article in RTMagazine.com called, "Reducing Readmissions in the COPD Population," by Robert Messenger (I wonder if that's a pen name).

Okay folks, I have no choice but to write about the future of healthcare.  Yes, I will delve into politics here, although it's something I must write about on this blog, because some of the changes that are coming to healthcare, compliments of the Patient Protection and Affordable Care Act, -- Obamacare, Affordable Care Act, Healthcare law, or whatever you want to call it.

This was a serious topic at our recent RT Meeting.  My boss says the newest measure that took effect October 1, 2013 is COPD reimbursement.  CMS already set reimbursement criteria for CHF, MI and Pneumonia, and now it is setting such criteria for COPD.  The goal is to diminish the cost the government has to pay.

The new COPD criteria for reimbursement says that if a COPD patient is readmitted to the hospital (ER and observation visits don't count) for any reason -- even if it's a stubbed toe -- the government will not reimburse for that patient.  Plus if the hospital has a poor showing overall -- a high rate of COPD re admissions -- CMS will punish that hospital by 1% this year, 2% in 2014, and 3% in 2015.

The goal here is that we need to work harder to prevent these patients from getting readmitted.  We need to be proactive.  We need to spend more money so the government doesn't have to.  This is not market driven, and it is not common sense.  It's impossible.  This is according to my boss, and, he says, according to his boss too.

He said government basically sat down one day and decided to look at diseases that cost the government a lot of money, and decided to set goals that were impossible for hospitals to meat.  In this way, the government won't have to pay, my boss said.  The problem, he said, was that the government costs will go down, but hospital costs will skyrocket.

The new criteria are impossible to meat, and within the next few years our hospital will be forced to close its doors.  The only hospitals that will be able to stay open will be large hospitals, and therefore there will be universal healthcare.  "I think this is the goal of Obamacare," he said, "to collapse the healthcare system and so people cry to the government for help."

Think of it this way: COPD patients usually have co-morbidities.  A patient could be admitted today for COPD, next week for CHF, the week later for kidney failure, next month for diabetes, and later on for GI bleed, and then  for a blockage in the intestines.  You see, you simply cannot prevent these patients from being readmitted.  These are our bread and butter.

Yes, the government knows COPD is the fastest growing disease, and #4 on the list of most common ailments.  So they simply are creating criteria that cannot be met so they don't have to pay.  Our hospital has already hired 30 people -- lawyers, statisticians, QA analyzers, accountants, etc. -- just to make sure we will comply with Obamacare.  This is all wrong, because the focus is no longer on patient care, it's on: how can we make money?

Some COPD patients are noncomliant, and there's no way you can get them to take their medicine.  Some patients won't wear oxygen, some won't wear BiPAP, and some won't take some unproven cancer medicine.  and I can't say I don't empathize with these concerns.  I wouldn't want to wear BiPAP, for example.

My boss said, "And you can disagree with me, but people get readmitted not due to poor quality of care (most of the time), they get readmitted because they are very sick people.  The government is too stupid or too blind to see this. Either that, or they are bound and determined to create a system that is guaranteed to fail.  Do they have an agenda here?  You decide."

I personally think it's good to create programs to decrease admissions, although I also believe a better incentive should be in place other than cutting government costs.  People talk about not fair, it's not fair that the government gets to pay less if hospitals fail, and there is no benefit to the hospital if the government fails hospitals.  That, to me, is not fair.

I personally cannot say I disagree with my boss.  I think the intent of Obamacare was to collapse the healthcare system.  I think all those people who said the following were either lying to sell the law, or are ignorant altogether:

• Obamacare is not a tax (the Supreme Court said it is)
• People won't lose their own insurance (many people are)
• Healthcare costs won't go up for you (they are, and by a lot, up to 146% in California alone)
• Healthcare costs will not go up they will go down (hmmmm?)
• Obamacare will only cost????? Every government program eventually costs most than they say!

Note: this post was not written with the intent to political bash a certain party.  Both parties are equally responsible for the current position of healthcare.  This is our problem, although it's one created by our government.  Our government, the one we have elected, has failed us big time. That's why Congress has a popularity rating less than 5% (and this rating has been consistent regardless of who controls it).  

And all of this stuff I predicted on this blog, and many of you guys said I was nuts.  I even got hate mail from some of my readers.  Trust me, I don't want to write about this stuff.  I am forced to.  It definitely effects what we do on the job, and it shouldn't.  Doctors should be deciding how to treat patient, not politicians.  It makes me sick just thinking about it. 

Thanks for allowing me to write my opinion.  Will

Now it's your turn.  Be nice!!!! However, before commenting, please educate yourself by studying the law, and reading posts like this over at RTMagazine.com. I believe the best way to improve healthcare is through education and passion.

The opinions expressed in this post may or may not be the shared by the authors of this blog.  

52 reasons we need a health system do over

Here are a whole bunch of reasons we need to start over with our healthcare system, and I'm referring to the entire healthcare system, not just the one in the U.S., or Canada, or Britain:

1. Common sense is better than dogmatism
2. Medicine is an art based on common sense, pharmacology is a science
3. The hypoxic drive theory was never proven, and neither were many other theories used 
4. Such as the one that states all shortness of breath must be treated with a beta adrenergic
5. Lab, x-ray and respiratory therapists should be respected as professionals
6. Doctors should be treated as equals
7. Medicines, tests and procedures should be ordered when needed, not just because
8. Order sets should be a list of recommendations, not mandates
9. Protocols should encourage competence
10. Smoking cessations should be recommended for patients who smoke, non makdated for all
11. We should not be encouraged to chart that of which we did not do just to meet criteria for reimbursement, i.e. smoking cessation, vaccinations, etc.  
12. Computer charting updates should be improvements and make charting easier
13. Medicine shouldn't be prescribed by men in suits sitting in leather chairs in capitols
14. Medicine should be prescribed at the point of patient care, i.e. by those at the bedside
15. Guidelines should help guide decision making, not mandate it
16. Doctors should not be saluted
17. Doctors should have to work a year or two as a nurse or respiratory therapist or EMT to get hands on experience and to learn how to work with people, like nurse practitioners and physicians assistance 
18. HMOs have been an utter failure.  They have increased needless procedures, and increased the cost of medicine, instead of the opposite.  
19. At present insurance companies get a discount on medicine, while private payers pay the full price
20. The government and HMOs pay a flat fee for hospital visits and services
21. HMOs have made it so asthma rates skyrocketed 180% between 1980 and 1995 (i.e. for medicare to pay for PFTs, an asthma diagnosis is indicated)
22. Private payers should pay the same for medicine as all others
23. Third payer systems eliminate patient questions like: "Do I really need this?"
24. Free medicine increases the cost to those who pay
25. Free medicine inundates emergency rooms, thus turning them into glorified doctor's offices
26. If it's free people will come, with their penile warts, simple cough, acne, overgrown toenails, and their common sniffles and sneezes, and aches and pains
27. There's no incentive to stay home and tough it out like grandma and grandpa did
28. Medicine should be a pay as you go service, and a start over would significantly lower the price so even the poorest among us could pay for it
29. Physicians shouldn't have to order procedures just to make sure the patient meets qualification for admittance (i.e. automatic IVs, hourly neuro checks, breathing treatments, etc.)
30. Pneumonia is the most reimbursable diagnosis, and therefore the most commonly diagnosed disease.  Ah, you see so many fake pneumonia diagnosis's that you can only imagine how skewered the statistics are.
31. With smoking cessation charted for every patient, statistics are skewered.  
32. Most pharmacology studies are funded by pharmacologists
33. Albuterol is a bronchodilator
34. Xopenex is a bronchodilator
35. Albuterol is safe enough to be an over the counter medicine
36. Xopenex is Albuterol
37. Advair will not kill you if you take an extra puff
38. Symbicort will not kill you if you take an extra puff, it's actually used as a rescue inhaler in Britain
39. Eurpoeans have access to more medicines
40. Americans should have access to new unapproved medicines to use at their own risk
41. People should be encouraged to not smoke, eat right, bathe, brush their teeth and exercise, not forced to
42. Studies should be interpreted correctly (i.e., 100 post op patients were given Albuterol and they were all eventually discharged, so now all post op patients are given Aluterol?  Huh? Or, new studies show those who used excess salt live longer.  Hugh?)
43. A 1960s doctor speculated Albuterol prevents post operative pneumonia, so now albuterol is automatically ordered via order sets on all pneumonia patients.  
44. In the 5th century B.C. Hippocrates speculated all dyspnea is asthma and should be treated as asthma.  What has changed?
45. Cardiac asthma is not asthma and is treated completely different
46. All that wheezes is treated as asthma
47. All wheezes are not bronchospasm
48. Upper airway wheezes are not bronchospasm
49. Audible wheezes are not bronchospasm
50. Dyspnea on exertion is heart failure, not asthma
51. Hospitalized patients should not need an order for 
52. One size fits all medicine does not fit all

How will Supreme Court rule on Obamacare?

Many people are asking me how I think the Supreme Court will rule on Obamacare.  My answer every time is that I cannot and do not make predictions.  I do not even like to write about things that have yet to happen, yet I am making an exception here because of all the questions and the importance of this issue.

The democrats in the House and Congress, and the President, believe Obamacare is necessary.  They believe a mandate to force every American to buy health insurance is necessary.  They believe the young and healthy should pay more for their health insurance to take the burden off the sick and elderly who canot pay as much, if at all.  They believe Insurance companies should accept people with pre-existing conditions.  They believe all of this stuff is needed, even if it's not Constitutional. Yet they beleive it is Constitutional. Either that or they don't care, as some people contend.

I'm not telling you how I think on this issue.  If you want to know what I think you can go back and read some of my archives.  I'm just writing here what other people say.  The democrates believe it's constitutional because of the commerce clause.  They believe people need healthcare, it's commerce, and therefore it can be regulated.  They believe everyone will need healthcare at some point, so they should all "pay their fair share."

Republicans believe the whole thing is unconstitutional because the 10th ammendment states that anything not mentioned in this here Constitution is left to the states and the people to decide.  They believe that no matter if Obamacare is needed, or wanted, or whatever, that it doesn't matter because it's unconstitutional.  They believe that no matter what the opinion is of the Supreme Court justices they should rule that it is unconstitutional becasue that is their job -- to rule based on the laws that exist on the books, with the U.S. Constitution beging the supreme law of the land; the superior law.

I would like to note here that what makes the U.S. Constitution so great, what made it last this long, what makes our Constitution older than any other, is that it does not tell the government what it can do, it tells the government what it can't do.  It limits the scope of government.  It prevents the government from making any law that takes away our natural rights.  So if Obamacare does that, if it takes away our natural rights, it should be ruled unconstitutional and shot down.

Some, those opposed to Obamacare, say it does take away natural rights.  They say that it will take away our right to choose where we buy something.  It will force you to buy something if you want to be an American.  It will force health insurance companies to accept people with pre-existing conditions even though that would be the equivelent of a farmer buying a barn full of dead cows: it would cause him to go out of business.  Some say Obama and the democrats want insurance companies to go out of business becasue then people would beg for a solution, i.e. a single payer government run healthcare system. 

Most of the opinions, the guesses, I've read say at a minimum the Court will shoot down the part that forces people to buy healthcare -- the individual mandate.  Yet if this happens, it may have to shoot down the rest of the law because without forcing healthy young people to buy healthcare and subsidize those who can't pay, there's no way to offset the cost of forcing health insurance companies to accept patients with pre-existing conditions.

So it's a complicated task set upon the Supreme Court Justices.  It's a task I wouldn't want to take up. Regardless, most Americans, according to Scott Rasmussen, as many as 54%, would like to see the law repealed.  An Associated Press poll shows that if the bill is shot down 77% want Congress and the President to work on a new healthcare bill.  The Supreme Court may shoot it down, by a 5-4 vote, and simply tell Congress to start over if it wants healthcare reform; to start over and obide by the Constitution.

Regardless, the U.S. Supreme Court is expected to make the much anticipated ruling today.  So by sunset tonight we'll be discussing the possible repercussions of whatever ruling is made.

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42 undeniable truths about healthcare

Surely some of these may be controversial, as the truth often is.  Yet the following are the 42 undeniable truths of the healthcare industry:

1. All medical professionals have an inert yearning to be self reliant and use the education and experience they've obtained
2. The way to improve the healthcare system is to get the government out of it.
3. The RT (doctor, RN) at the bedside knows what's best for the patient more so than an order set
4. Order sets are are socialistic and are an excuse for doctors and nurses to be lazy
5. Protocols are capitalistic and encourage thought
6. I am not arrogant
7. Supervisors quickly forget what it was like to work on the patient floors
8. The way to reduce healthcare costs is to make everyone pay for each service
9. DRGs increase medical waste and lying about a diagnosis just to assure reimbursement
10. Keystone Committees are an attempt to enforced socialized medicine
11. Evidence Based Medicine is a nice way of saying everyone must do it the same
12. Intensity of Service is an excuse for doctors and nurses to lie
13. Quality Assurance Analyzers are only needed because the government is involved in healthcare
14. Tylenol is not a default cure for all that ails a patient
15. Throwing everything at a patient in the hopes something works is not common sense
16. Regulating hospitals does not make for better healthcare, it makes for fewer hospitals
17. We need more humor in healthcare
18. Bronchodilators treat shortness of breath due to bronchospasm and nothing more
19. They hypoxic drive theory was a hoax created to make respiratory therapists relevant in the 1960s
20. Xopenex is the same as Albuterol with the same effect and same side effects. 
21. IPPB does not work better than patient coaching with an incentive spirometer to treat and prevent atelectasis, and studies prove this.
22. Too many patients are put on a ventilator out of panic rather than logic
23. Much of what respiratory therapists do is either a waste of time or delays time
24. Dyspnea with exertion is not asthma and should not be treated with a bronchodilator
25. If it's audible it's not bronchospasm
26. If it's coarse it's rhonchi.
27. The best way to hear lung sounds is to use a stethoscope on the patient's chest
28. The best way to assess a patient is by touching the patient (not by talking over the phone)
29. It's immoral to NT suction an awake, alert and orientated patient
30. Respiratory therapists are not ancillary staff (they are professionals knowledgeable in an area beyond the scope of most physicians)
31. Doctors and nurses who are stupid about respiratory therapy don't know they are stupid about respiratory therapy and most will never admit it
32. If you refuse to do a breathing treatment that isn't indicated you are not being lazy
33. BIPAP does not help fulmonating edema by forcing fluid out of the lungs, it reduces fulmonating edema by reducing venous return and therefore reducing cardiac output so the heart can catch up
34. Supplemental oxygen will not treat anemia, and is not indicated just because someone has chest pain because if all the seats on a bus are full, the extra passengers won't get a seat
35. The truth hurts before it makes you better
36. Scientific evidence disproves that albuterol will treat pneumonia, CHF, rickets, cystic fibrosis, lung cancer, pulmonary embolism, pneumothorax, pleural effusion, detox, dehydration, and even emphysema and chronic bronchitis.  It only benefits these patients if asthma (hyperactive airways) is a component of said ailment.
37. All that wheezes is not asthma
38. All dyspnea is not asthma
39. If a patient is obnoxious, annoying, belligerent, rancid, or has maggots, respiratory services are not automatically indicated
40. Order sets and physician convenience are not indications for using the word stat.  
41. The clinical picture doesn't always match the science (i.e., hypoxic drive hoax, hoaxenex, and studies showing inhalers work the same as nebulizers)
42. Some studies are conveniently ignored by the medical community (such as beta adrenergic receptors don't exist in lung parynchema and renal tibules.)

Did Dick Cheney deserve a new heart?

Former Vice President Dick Cheney continues to have a healthy spirit, a joy of living, an eagerness to live, and a good quality of life -- even at the age of 71. He and his physicians decided he was a viable candidate for a heart transplant.  After waiting 20 months, a heart transplant he received.  And all goes well, or so we are told.

Except, some are claiming he was too old, and that someone else should have received that heart.  Some say he gained special favors due to his status.  Some even are as farfetched to say he's too conservative to deserve a new heart.  These few believe that a "rule" should be set in place that doesn't allow a doctor, patient and insurance company the right to add a patient to the heart transplant list who is above a certain age.  These people believe "they" should decide who lives and dies, and not the patient.  I believe the term some use for this is "death panels."

Instead, they believe people who are too old  should just "take the painkiller," as Obama said to Jane Sturm when she asked him in June, 2009, if he would let her 100 year old mother, who could afford it, and had a "spirit" and a will to live, get a pacemaker. 

Obama said:  " I don't think that we can make judgments based on people's 'spirit.'  Uh, that'd be, uh, a pretty subjective decision to be making.  I think we have to have rules that say that we are gonna provide good quality care for all people.  End-of-life care is one of the most difficult sets of decisions that we're gonna have to make.  But understand that those decisions are already being made in one way or the other.  If they're not being made under Medicare and Medicaid, they're being made by private insurers.  At least we can let doctors, you know  -- and your mom know -- that, you know what, maybe this isn't gonna help.  Maybe you're better off not having the surgery but taking, uh, the painkiller.

For his fame and fortune, Cheney earned no special favors.  While the average wait for a heart transplant is three to six months, Cheney waited 20 months to get his.  And it wasn't like he broke the rules to get on the list.  In the past there was an age limit of 55, yet age is no longer a determining factor.

The qualification now is good kidney health, no stroke history, and a good quality of life.  So as long as the physician, insurance company and the patient think it's a good idea, then any person, regardless of age, qualifies for a heart transplant. 

This is a good thing, I think, because a new heart can buy a person, on average, six to seven years of quality life.  Surely there are complications to getting a heart transplant, the least of which is taking medicine every day to prevent your body from rejecting the heart.  Yet if you love life, it should be YOUR decision to make, not some rules made by some non-medical workers who sat in leather chairs in Washington 20 years ago. 

Yet this is where Cheney's new heart enters the realms of politics.  Many claim that Cheney made a selfish decision and he should have just "taken a painkiller."  He should have just let himself die.  Yet he didn't.  In our free society, he was able to choose to live.  I think this is good.  I think the decision to live should be made by the individual person, not a set of criteria, order sets, rules, or what not.

This is where I have a problem with Obamacare.  Once Obamacare is fully enacted, and the government is paying for health care, they are going to want to cut costs.  This is when costs will matter.  The government will set criteria for who will live and who will die.  It may not be passed by law, but it will happen by default.  It will happen because healthcare is expensive, and Uncle Sam will want to lower his costs.

Why do I think this? Because i't already happens as Obama noted in his statement above.  Look at Medicare and Medicaid and Diagnosis Related Groups (DRGs).  They already tried to cut costs by setting criteria for hospital admissions and criteria for reimbursement.  No matter how sick you are, your doctor or hospital will not be reimbursed unless you meet certain criteria.

In this way, to meet such criteria, we now have order sets.  When you are admitted, certain procedures and tests are "automatically" ordered based on your diagnosis. They are called core measures, intensity of service, and order sets.  Since I've already discussed these in the links provided I won't go into further detail here.  Yet what treatment you get when you are sick is not always what your doctor thinks is best for you, but what the "rules" say you must get.

When you're flipping your own bill you get to decide the future course of your medical treatment.  However, when your mother -- which in this case will be the government -- is flipping the bill, she gets to make decisions for you.  Since she's flipping the bill, you have to follow her rules.  And with Medicaid, we already do this.  We have rules.  We have criteria.  We have many, many, many, many things that are ordered that you will never need, but we will do them just because someone sitting in a chair in Washington decided you needed it, in many cases, years before you were ever even sick.

In the future such "criteria" may determine whether you get that pacemaker or heart transplant, I think this is bad, scary even, because it results in a sheet of paper deciding your treatment, rather than caregivers and family members at the bedside, and despite the spirit, desire to live, and wishes of the patient. 

The bottom line here is what I have been preaching all along on this blog since it's inception in October of 2007:  decisions about how to proceed with patient care should be made by the physician, family and patient, not by set of rules and guidelines.  Every patient should be treated individually, not as a collective.  I say this because every patient is unique; every patient is an individual, not a number.

So did Dick Cheney deserve a new heart?  If he has the desire to live, and the means of funding it, then YES HE DID!  It's not up to you or me to decide what's best for Dick Cheney, it's up to Dick Cheney.  That's my humble opinion, what is yours?

My solution to fixing the healthcare industry

Running a medical care facility is as complicated as caring for an end stage COPD patient.  While a doctor will need to find the right balance of medicines to deal with all the facets of lung disease -- bronchospasm, heart failure, anxiety -- hospital administrators need to find the best potion to keep the hospital afloat.

Finding the best potion is accomplished by balancing the following core goals:

1. Improving patient care
2. Reducing costs
3. Creating a good image of the institution
4. Maintaining a good morale among employees

What is the current trend?

The current trend is to focus on 1-3 above, and to incorporate employee morale into a public relations campaign which involves things like midnight meals provided by administrators, summer parties, Christmas parties, giveaways, and having administrators participate in meetings.  While this is a step in the right direction, it has done nothing to improve morale.  However, studies show the current trend has improved patient care.  

All of the above goals can be accomplished through the creation, implementation and monitoring for the following methods:

1. Order sets
2. Protocols

Quite often these two terms are used as synonyms, and more frequently an order set is called a protocol.  I think this is done more as window dressing, because most people in the medical profession believe every patient and every situation must be treated individually.  It didn't used to be this way, yet this is the current trend.

In reality, the difference between order set and protocol is similar to the difference between capitalism and socialism.  One allows for individualism, and the other creates equality.  While one might "sound" like it solves problems better, the other actually does.

So what are hospitals presently doing right, and what can they do better?  To answer these questions we must first have some definitions:

Order set:  Synonym:  Social Justice, socialism.  Every patient with a given diagnosis (DRG) is treated the same.  Once a patient is admitted with a certain DRG, these sets pre-determine what you order for that patient.  The purpose of these is to make sure best practice medicine is followed for every patient.  Basically, a committee -- usually in Washington -- determines what is best for the patient, and this assumes that the caregivers at the bedside are not capable of critical thinking.  Another advantage of order sets, and the reason they are being initiated in most hospitals, is to make sure intensity of service is met.  This assures that the patient will meet reimbursement criteria.  In the past physicians were presented with a sheet that listed all the options.  Today, however, many of these options are pre-checked and automatically ordered whether the doctor wants to or not.  The reason for this is to make sure reimbursement criteria is met (see below).

Cook book medicine:  Treating all patients the same.  This is generally the theme created to describe order sets, especially order sets that have pre-checked boxes that result in procedures being automatically ordered for a particular DRG.

Protocol:  Synonym:  Capitalism, individualism.  Every patient and every patient situation is treated individually and uniquely given the patient status and the wisdom of the caregivers.  The institution has set guidelines, and the caregivers use their education and wisdom to solve the problem at the bedside. Given proper training and well written protocols, best practice medicine should occur by default because protocols encourage critical thinking.

Ideally, according to Egan, a protocol would work like this:

1. Therapy can be adjusted more frequently in response to changes in patient status.
2. Physicians can still be contacted for major changes, but not minor adjustments, thus reducing nuisance calls.
3. Consistency of therapy can be maintained and nonpulmonary physicians can use appropriate up-to-date methods by simply requesting that protocol therapy be used.
4. RCPs (Respiratory Care Practitioners) become actively involved in achieving good patient outcomes instead of performing rigid tasks. This enhanced responsibility attracts and retains better educated and qualified practitioners.

Advantage of protocols:

1.  Benefits the patient:  The medical professionals working with the patient (RT and RN) decide what the patient needs at the moment the care is needed.

2.  Less calls to physician:  Doctors will receive fewer irritating phone calls

3.  Improved morale and apathy:  RTs and RNs will be able to use the wisdom they obtained by education and through experience, and this will improve their dignity, mercy and self worth.   

4.  Less burnout:  With only those patients who need therapy receiving it, there is a good chance the RT or RN won't feel so run down and overwhelmed, and the patients who truly need their services will benefit as a result.


Reasons your hospital might choose not to use protocols:

1.  Procedure counts:  RT bosses need procedure counts to justify staffing load.  They fear, and often needlessly so, that protocols will result in less work for the department

2.  Reimbursement criteria:  Quality Assurance (see below) wants to make sure government quotas are met for each given patient.  If the RT decides a patient doesn't need certain procedures (such as bronchodilators), then the hospital may not be reimbursed.  This is one of the main reasons many smaller hospitals avoid protocols (note:  see reimbursement criteria below).

Order set/ Protocol combination:  This is where a hospital committee creates order sets for a given DRG yet allows the medical staff freedom based on well designed protocols to use critical thinking in determining what is best for the patient.  Once order sets are initiated, the caregivers at the bedside (RN and RN) decide which ones are to be followed and how.  For example, a post operative order set may include an incentive spirometer order.  By using the protocol, the RT will decide whether the IS is appropriate, or if cough and deep breathing might be better for that particular patient.  An Albuterol breathing treatment is another example.  A pneumonia order set may automatically order Q6 breathing treatments.  The RT will give an initial breathing treatment and monitor it's effectiveness.  If there is no benefit to the patient and the patient the order would be changed to as needed or discontinued.  This would save the hospital money (treatments are $80 to 100 each) and allow the RCP an opportunity to help patients with greater needs.

Order sets are the current trent.  Personally, I think these have some advantages.  It assures that best practice medicine is followed.  So, what is best practice medicine?

Best practice medicine:  Based on scientific evidence, this is what is proven to work for a given DRG.  For example, breathing treatments improve work of breathing for asthmatic patients and should be ordered.  Likewise, oxygen should be an option.  This also focuses on preventative medicine.  Incentive Spirometers use is proven to reduce post operative pneumonia and atelectasis, and therefore an IS order is automatic with post operative order sets. 

Intensity of Service:  Basically, does the patient meet reimbursement criteria?  Is the patient sick enough to be admitted?  Doctors would prefer to use their own judgement to decide which patients go home and which patients are admitted for observation.  Yet the Centers for Medicare and Medicaid Services (CMS) will refuse to reimburse the hospital for a patient admission unless the patient is sick enough to need certain pre-determined procedures.  For example, if a patient admitted with asthma didn't receive any breathing treatments, then why did he need to be admitted?  If no treatments are given, CMS has a right to refuse reimbursement.  Order sets make sure what is required is given regardless of need.

Keystone Committee:  This is a committee formed to make sure intensity of service is met, reimbursement criteria is met, and best practice medicine is met for each DRG.  The goal is to reduce costs for the hospital,  make as much money for each DRG, and to provide best practice medicine for each DRG that results in improved care for the patient. 

Core Measures:  These are measures set by the Keystone Committee that work as goals for the hospital to improve patient care and reduce costs.  They are based on best practice medicine and reimbursement criteria.

Quality Assururance (QA):  This is the fastest growing area of the medical field, especially since the passing of Obamacare.  This is the department responsible for checking charts and making sure core measures are met.  The goal here is to make sure the hospital is making as much money for a given patient as possible.  They also work on committees with other department heads in the hospital to create methods of assuring best practice medicine and reimbursement criteria is met. T'his is a noble department set to make sure the patient is getting the best care possible and the hospital is making a profit.  However, because of government regulations on the medical field and new regulations imposed by Obamacare, one of the main emphasis's of late is on meeting these regulations. 

This department hides under the guise of best practice medicine, although their real intent is always to make sure the patient is profitable.  They're often referred to as the nitpickers of the hospital, or the people who make sure we dot all our i's and cross all our t-s per se.

Quality Assurance Analyzer:  This is one member of the QA team who is a former nurse who has the responsibility of reviewing charts to make sure intensity of service is met for each patient.  They carry a book around with them created by an independent company that lists all the orders for a given DRG that must be ordered for that patient to meet reimbursement criteria.  It is illegal for the QA analyzer to tell a doctor the patient doesn't meet criteria because a certain order was not made.  For example, it is illegal for the QA analyzer to observe treatments were not ordered for an asthma patient and to tell the doctor he must order them so the hospital gets reimbursed.  However, doing this is part of their job.

Reimbursement criteria:  This is criteria set by CMS that must be met for each DRG.  If not, CMS has a right to reject reimbursement for that patient.  If CMS deems a patient was not sick enough to be admitted, they will not reimburse the hospital.  It does not matter that the doctor was worried about the patient and wanted him admitted for observation.  This is one of the main reasons many procedures are added to order sets that are not needed:  Ted stockings for every patient, neuro checks every two hours, IVs, EKGs every morning times 2 days for chest pain patients, bronchodilators for RSV patients and pneumonia, etc. We must also note that the purpose of reimbursement criteria is to reduce cost to the government, not to reduce cost to the hospital.  Since these actually increase the number of procedures ordered to meet criteria, this actually results in increased cost to hospitals.

The only way to reduce costs when you have order sets is to also add protocols.

Public relations:  Creating a good image of the hospital in the community and among staff working for the facility.

Diagnosis Related Group (DRG):  This is a diagnosis related group and each patient is assigned one.  Based on the DRG chosen, the hospital will receive a set payment.  Because hospitals know in advance how much they will make for that patient, this may help determine the type of care this patient receives.  Because there is a flat profit, hospitals therefore have an incentive to do only those procedures that are essential.  Thus, the fewer procedures the hospital does the more money the hospital will have once the bills are paid.  This is an incentive to do more with less.  One of the best ways to do more with less is to have order sets and protocols.

What are the current trends? 

The current trend is for hospitals via keystone committees (or something similar) to create order sets for every DRG.  In the past this included a list to remind a physician of his options.  However, more recently it's evolved into simply checking options so that nothing is missed.  The goal is to meet core measures.

However, we must keep in mind that while the intent is to improve quality and decrease costs, it is my assessment that due to government intervention, not enough common sense is involved in the process.  The emphasis is moving away from protocols and toward order sets that make certain orders are mandatory regardless of need.

The result of this is the following:

1. Increased workload on all staff
2. Increased ordering of procedures that are not needed
3. Increased burnout
4. Decreased critical thinking
5. Decreased morale
6. Increased apathy
7. Decreased dignity, mercy and feeling of self worth
8. Worsening of patient care (due to burnout and apathy)

What is the best approach to take in the future?

I believe the best approach to accomplishing the four core goals for hospitals is to take a combination approach to public relations, order sets and protocols.  I believe order sets will assure core values are met, and protocols will assure costs are reduced and morale is improved.

With a fine balance of public relations, order sets and protocols, the following will be the result:

1. Improved patient care results in improved patient satisfaction and outcomes
2. Improve individual choice results in improved worker morale and feeling of self worth
3. Reduce unnecessary procedures lessens burnout and reduces apathy
4. Improved option results in a reduction of redundant  and unnecessary phone calls to physicians
5. Increase critical thinking at the bedside likewise improves patient care, reduced calls to physicians, and improved worker satisfaction
6. Improved morale would result in better word of mouth advertising by staff and physicians

However, due to government regulations and reimbursement criteria, hospital committee members are forced to make reimbursement criteria a top priority, and, unfortunately, this comes at the expense of patient outcomes and worker morale.  Due to order sets that pre-mark and automatically have certain procedures ordered, this results in the staff becoming overwhelmed.

A good example of this is if a patient is admitted with sepsis, COPD, pneumonia, asthma, heart failure and anxiety.  The order sets for all those DRGs must be followed.  The unit secretary can be bogged down for hours just on one patient, and implementing those orders will bog down a single nurse, and often require a second nurse and a nursing assistant.

With limited focus on creating protocols, there are no methods of getting rid of redundant and unnecessary procedures.  This results in staff being overwhelmed, it causes burnout, and it results in apathy.  Due to the recession, most hospitals are unable to hire new nurses to help out.  Burnout, decreased morale and increased apathy is the result.

This effects public relations too, because a staff that is burned out is going to have a poor view of the institution and the administration, and will be less likely to spread a positive word about the hospital.  This makes the job of public relations more complicated.

With any future approach to medical care, you'll obviously want to continue positive trends and get rid of what doesn't work, and add what has worked at other hospitals.  The problem is due to government intervention, most hospitals are a) forced to set core measures based on reimbursement criteria, and b) forced to do things the same way.

This takes away individualism.  Since all hospitals are doing things the same way, this decreases  the implementation of new out of the box ideas that might revolutionize the medical industry in the future.  If forces hospitals to focus in one area (reimbursement) and slack in others (worker morale).

I think Keystone Collaborative Core Measures have improved patient care.  One recent study shows that critical care core measures have reduced ventilator acquired pneumonia and reduced readmission rates for pneumonia and COPD.  Yet gains in this area have not improved worker morale  and have not improved hospital image within the institution and the community.

Likewise, when worker morale is low, so too is patient morale.  On top of this the patient is needlessly having to be awakened every time a staff has to come into his room to do a certain procedure. Apathetic and overwhelmed RTs and RNs aren't going to care about working together to make sure the patient isn't awakened every hour.  Apathetic and overwhelmed staffers are simply going to do what they have to do to get their assigned work done.

They, in essence, become overwhelmed button pushers and automatons.  They become robots.  This is bad because these RNs and RTs are right at the bedside and provide an image to the patient of the hospital.

I believe the best way to accomplish all of the above four hospital goals this is via the following:

1. Reduce government regulations on healthcare industry that discourage innovation and create an emphasis on reimbursement criteria over patient outcomes and worker satisfaction
2. Continue the Keystone Collaborative to set core measures that focus mainly on best practice medicine and less so on government regulations and reimbursement criteria.
3. Creating a combination of order sets that remind doctors of the core values 
4. Creating protocols to allow point of care fine tuning of order sets to meet patient needs and improve worker satisfaction which will in turn result in improved patient satisfaction with the hospital
5. Reduction of costs because only procedures that are needed will be given

It's a tough balancing act to find at potion that works to improving patient care, reducing costs while creating a positive work environment that lends itself to good worker morale, and lends itself to good word of mouth advertising to compliment a positive public relations campaign.  

Yet I truly believe less government intervention will result in more creativity by individual medical institution in accomplishing the four goals:  improving patient care and outcomes, reducing costs, creating worker satisfaction, and improving the hospitals image.

A combination of core measures that result in a positive balance of order sets and protocols that assure best practice medicine is met at the same time as worker and patient satisfaction is accomplished.  

It is possible to accomplish all the above goals at the same time, yet it will take a collaborative effort on the part of hospital administrators, nurses, respiratory therapists, patients, and Congressmen and Senators on both the state and federal level.  

The goal should involve increasing individual thought, and decreasing cook book medicine.

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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?

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Less government equals less healthcare costs

Here's a perfect example of why healthcare costs so much. I went into the patient's room and she said the following:

I have no insurance. I have all the stuff to take a breathing tx at home. I know as soon as you start the treatment it's going to cost me $100, and I'm going to have to pay it. If you can talk to the doctor and have him write me a prescription for Albuterol solution, I can get it for $4 and I can give my self treatments for free at home."

You see, she is paying for her own medicine, and so she questioned what the doctor ordered. Because she was paying on her own, she didn't want to pay for it.

Now if she had health insurance, and if she had medicaid or medicare, and she never saw the bill, then she wouldn't care what the cost of that treatment was. She wouldn't have questioned the order.

This is a perfect example of why we need to have a healthcare system where there is an incentive to question the order. The truth is, at present, most of us don't. And that's why healthcare costs so much. It costs so much because people keep getting, and they don't pay. Since someone else is paying, they don't question the order.

Think about it. If you give something away for free, everyone is going to come running to buy it. So while supply of hospitals, doctors and medical equipment stays the same, demand for it goes up because it's free. Per basic economics 101, the price has no choice but to go up.

The best way to get the price of medicine to go down is to force people to pay for it themselves. Back in the 1960s this is how it was, and medicine was affordable. Ever since the advent of Medicare and Medicaid and HMOs and third party payers, healthcare has skyrocketed.

It's not a coincidence. The way to get healthcare costs down is to get the government out of it. The way to get healthcare costs down is to get Jane and John Doe to question the therepy they are being provided.

That way, what isn't needed won't be given. What's needed they will pay for. And yet the healthcare reform bill passed 6 months ago does exactly the opposite of that. It places more patient's on the government dole, which means more free (but it's not free) medicine for more people.

Look, there are some people who really, truly cannot work and really, and truly could use a helping hand. I'm all for them getting help. Yet that system of helping out the needy, or our retired parents, has gotten out of hand or out of control.

It's time we had more patients like I had today. The patient who says, "Hey, before you open that and charge me $100 bucks..."

Crossfire appreciated, yet no flames aloud.

What will happen to us RTs???

My coworkers and I were having a discussion a few days ago, and the topic was: What will happen to respiratory therapists if Obama's Healthcare plan is eventually signed into law by the president. The general consensus was that many of us may need to look for new jobs.

First of all, the first thing Obama would order to diminish healthcare costs is for a complete and thorough investigation into procedures ordered and whether or not they are really needed. Hence, once this investigation gets to the RT Cave of any hospitals, a stunning revalation will be made: 80% of bronchodilator breathing treatments ordered are not indicated.

Right now the RT Bosses of the RT Cave count the "un-needed" bronchodilator orders as procedures, and the more predicted procedures the more staff positions are justified. If this procedure load is lapsing, then there is no way to justify, say, having two RTs on during the day.

After such an investigation, doctors would be instructed to attend "bronchodilator instruction classes," where they will be informed on the correct times where it is appropriate to order bronchodilators.

The end result here is doctors won't want to think that hard, so they will piss and moan enough for Obama to mandate (make an executive order) that all hospitals within the U.S. incorporate RT Driven Protocols that make sure that the RT decides who gets breathing treatments.

The good news is obvious: we'd have the protocols we've yearned for for years.

The bad news is obvious too: fewer RTs will be needed. We RTs on the low end of the totum poll will be out of luck, as will many to be RTs just finishing RT School.

Of course, when it comes to the government making decisions such as this, you never know what to expect. The alternate course will be that government bureaucrats will think along the lines of the RT Bosses, who would rather pay for un-needed therapies as opposed to forcing thousands of RTs out of a job.

Those who run the government, as you know from recent stimulus bills filled with pork projects, sometimes prefer to spend money where it isn't needed to stimulate demand and create jobs. If this is the route bureaucrats decide to take with RTs, then we are safe -- although we ardent supporters of bronchodilator reform will continue to cry foul.

It's possible our position may be absorbed by nursing to the detriment of the patients, and all us RTs will be out of a job. No disrespect to nursing here, but we are the one's with all the RT Wisdom. The major decider here: money!

And, what happens to us RTs will not be made by thousands of independent hospital administrators where we work, but by one bureaucrat sitting in a chair in Washington. He will decide, because he knows what's best for everyone.

So, if you're not a gambler, perhaps you best call your local U.S. Representative and U.S. Senator and make clear your opposition. On the other hand, if you're a gambler, stay put and hope for the best.

Note: This is an editorial and does not necessarily represent the views of the publication.

Two well respected doctors discuss health care

After the code in the critical care unit I was standing behind the nurses station listening to the anesthesiologist and the Internist discuss how much they hate President Obama. I did not participate other than to say:

"You better not say that in front of Susan." Susan, of course, is the CCU RN who was in charge of the patient we just coded.

The Anesthesiologist said, "I think he is wrecking the country."

The Internist said, "I voted for him, and I think he is doing a terrible job. He's not doing what he said he would do when elected. He is trying to solve all the world's problems."

"I'd have to agree."

"And now he wants to screw up the health care system. You would agree that we do have the best health care system in the world do you not."

"I do."

"The only problem is not the health care system, but the cost. The government has made some stupid laws in the past that make it too easy to sue doctors. Because of this, we doctors have to order procedures that often are not indicated."

I was shocked they were saying this in front of me. I stood as still as a deer hiding in the woods during rifle season hoping they wouldn't figure I was standing right behind them.

"I mean," the Internist said, "He's trying to solve all the world's problems, to rush all these bills through Congress, when it's not even possible that he nor any one else has even read the bills. This is what you call anarchy. I say this and I voted for him."

The anesthesiologist said, "I don't see why you are surprised, because he's doing exactly what he said. But I completely agree with you he is rushing too much too fast."

Susan arrived at the station, and the discussion stopped on a dime.

Here's a great con to Nationalized Healthcare

Here is one very good reason I am against a nationalized health care system. I discussed with my boss yesterday about the budget. He said his bosses want him to come up with "everything and anything" ideas for further cutting the budget.

He asked me, "Any ideas."

I said, "Create a treatment protocol so we can get rid of all the breathing treatments that are not needed. That would save us a ton of money." (To learn how much money this would actually save our hospital, click here.)

He said, "Rick, you should be happy just to have a job. We need all the procedures right now we can get."

Here's something to consider. The hospital does not get paid by the government per procedure completed, it gets one flat rate for the patent's stay. So, the fewer procedures done while the patient is admitted the more money the hospital would make.

Thus, if Shoreline Medical Center could come up with a protocol to prevent doctors from giving an asthma/COPD medicine just because a patient is short of breath or sounds bad or looks funny (or to prevent bronchodilator abuse), that would save the hospital hundreds of thousands of dollars a year.

What I understand here is that when it comes to cutting the hospital's budget my boss only thinks in terms of his own wallet, while ignoring the wallet of everyone else. What he fails to understand (what many people seem to misunderstand these days) is the government's wallet is OUR money too.

My boss is afraid if we get a protocol, the number of procedures in our department will go down, and someone will lose his or her job. It seems to me many hospital bosses would prefer the procedure than to prevent government waste.

Yes government reform is needed, but not in the direction the current House, Senate and Executive Branch visions. The change we need is to provide an incentive for hospital admins to spend the government's money as wisely as it spends it's own.

As the old saying goes: people are more likely to spend their own money wisely, yet when it comes to spending someone else's money, they appear to be less wise (or is that a saying I just made up). Anyway, it's true.

Feel free to discuss because, as always, I could be mistaken.

(Other than the links above, for more of my opinion on Nationalized Healthcare, click here.)