Saturday, April 20, 2013

When Hospitals Make Bigger Profits: Disinformation Debunked

This article makes me see red:

This is disinformation.

I am seeing safety being cut in patient care due to risk of not being paid because of complications.

For example, a foley catheter is routinely inserted in surgery to allow for the urine to be collected during the operation, and in the recovery period after. This is important because to the anesthesiologist, the kidneys are the proverbial 'canary in the coal mine'--when there is insufficient blood flow to make urine, the anesthesiologist adjusts the amount of fluids given, blood pressure, and heart rate to increase the urine flow. On long cases, over three hours, I insist on foley placement also because in my opinion, no one, conscious or unconscious, can hold their urine for much longer than that. (The bladder stretches too far and is not able to void properly once it has been stretched. It will need a catheter for twenty-four hours to allow the bladder to 'rest'.)

A foley catheter is a tool I use to help manage my patients intraoperatively.

Increasingly surgeons are choosing not to insert them to avoid the penalty of not being paid for a urinary tract infection.

Complications happen. It is part of doing business. Medicine is science but not amenable to 'assembly line' philosophy. Every patient is different.

And many patients present with very high risk for surgery. The airway is un-intubate-able due to obstructive sleep apnea and morbid obesity. The diabetes makes infection of the surgical site much more likely. The underlying cardiac disease makes the patient more vulnerable to the effects of anesthesia.

Long story short--when there is threat of no compensation due to complications, physicians will not do the case.

Let me repeat: when the risk of a poor outcome is high enough that there is a good chance the hospital and care team will not be compensated for their services, only the best candidates for surgery (the healthiest) will be allowed to go to the operating room.

'Do the right thing' is a terrible twist of the facts. Don't buy into it. If you have had complications in the past, surgeons are going to think twice before they decide to take care of you the next time.

Already now, I know they are not providing gowns or taking vital signs for routine post-op visits, and are keeping them as short as possible, because to do what they used to do under the current rates of reimbursement from insurance would simply drive them out of business. Someone I know just retired after forty-nine years in private practice because they could not afford the rent for the office, the malpractice insurance, and all the rest to keep their practice afloat. It just wasn't worth it.

In anesthesia you will see a trend of less physicians and more nurses giving anesthesia, because the insurance companies and hospitals are looking to save cost. Already Medicare is paying twenty cents on the dollar for every anesthesia service that is provided; in no other specialty is the compensation so much lower than insurance rates. In some areas, Medicare patients are not welcome by primary care physicians, and patients have to drive hundreds of miles to the nearest big city to obtain basic medical care.

There is no better time to bring Reiki into traditional medicine, isn't it? Spirit needs to be asked to step up to the plate and help this entire establishment turn itself around.

That is my dream That is my heart's desire--to bring 'Heal' into 'Healthcare' again.


Reiki Doc