Rep Retirement Lodge 201: A State You Don't Expect

[leswp1]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Is everyone out on the golf course at the COuntry Club?

Good Afternoon Lodge!

 

[Scarlet]

Re: Rep Retirement Lodge 201: A State You Don't Expect

I WISH!!!

Back at my place today. I have two doctor appointments tomorrow morning in Cambridge. Easier to get to from my place than my mom's place. We'll head back up to her place afterwards. If you want to come visit les, bring ice cream!!!

I'm hoping he's going to change this cast tomorrow. I'm about done with this one. I can tell the bruising is going away because my leg is kinda yellow. It's definitely still swollen. Still hurts, but very manageable. It's more uncomfortable than painful. I'm looking forward to seeing what was done. He mentioned he was making three incisions. He also said once he changes out the cast I can take a shower. I bought one of those cast covers. My mom is going to get a shower chair from the senior center.

Do you guys think it's odd I never received any follow up calls from either his office or even the hospital? I do. I figured maybe a nurse or a PA or someone would call to make sure I made it through the first night. They have my cell as well as my home phone (I was at my place through Saturday).

 

[leswp1]

Re: Rep Retirement Lodge 201: A State You Don't Expect

I WISH!!!

Back at my place today. I have two doctor appointments tomorrow morning in Cambridge. Easier to get to from my place than my mom's place. We'll head back up to her place afterwards. If you want to come visit les, bring ice cream!!!

I'm hoping he's going to change this cast tomorrow. I'm about done with this one. I can tell the bruising is going away because my leg is kinda yellow. It's definitely still swollen. Still hurts, but very manageable. It's more uncomfortable than painful. I'm looking forward to seeing what was done. He mentioned he was making three incisions. He also said once he changes out the cast I can take a shower. I bought one of those cast covers. My mom is going to get a shower chair from the senior center.

Do you guys think it's odd I never received any follow up calls from either his office or even the hospital? I do. I figured maybe a nurse or a PA or someone would call to make sure I made it through the first night. They have my cell as well as my home phone (I was at my place through Saturday).

Let me know when you are back here.

No one used to make phone calls. THey don't even seem to do discharge planning anymore. When mum les had surgery a few yrs ago she was going to be unable to wt bear for 12 weeks and no one did a bit of assessing or planning for that until AFTER the surgery when she was no longer mobile AND she was still considered under the influence of anesthesia. The wonders of the business model for medicine and why it doesn't doesn't work.

 

[The Rube]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Well, today was a sh*show at work. Uber busy, did get some help, but one of the machines that the dumbarse mechanic took a week to fix broke down with the same issue he fixed. Got stuck in the middle of an aisle. Got it out (have to use a forklift to even move the machine), mechanic came back, fixed it, and as he was going to park it, it broke again due to the same problem. Had to fix it AGAIN. I am pretty sure he is not qualified for his friggin' job.

2 more days until a week of freedom.

 

[MarkEagleUSA]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Good morning to tLodge!

 

[JF_Gophers]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Morning.

The wife has approved a MN state fair trip this year. Likely it will be on the last weekend as that is already a long one due to the holiday.

 

[Swansong]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Let me know when you are back here.

No one used to make phone calls. THey don't even seem to do discharge planning anymore. When mum les had surgery a few yrs ago she was going to be unable to wt bear for 12 weeks and no one did a bit of assessing or planning for that until AFTER the surgery when she was no longer mobile AND she was still considered under the influence of anesthesia. The wonders of the business model for medicine and why it doesn't doesn't work.

Case management workload is .... extreme. It's not surprising that patients fall through the cracks. I trained our CCM staff on Epic a couple years ago - these were very serious, very dedicated people who had ten times the work they should have been saddled with. I've no idea why anyone would ever want that job.

 

[Greyeagle]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Case management workload is .... extreme. It's not surprising that patients fall through the cracks. I trained our CCM staff on Epic a couple years ago - these were very serious, very dedicated people who had ten times the work they should have been saddled with. I've no idea why anyone would ever want that job.

What....no love for Bauer?

 

[leswp1]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Case management workload is .... extreme. It's not surprising that patients fall through the cracks. I trained our CCM staff on Epic a couple years ago - these were very serious, very dedicated people who had ten times the work they should have been saddled with. I've no idea why anyone would ever want that job.

It is structured to fail. Used to be discharge planning was a huge focus of the nurses' job. Then, with the roll 'em in and roll 'em out fast as you can mentality, this has almost totally disappeared. No longer a proactive approach but a reactive one. Mind boggling to me as a good discharge plan forestalls all sorts of over utilization afterwards and the way reimbursement is structured they lose cash if the person is readmitted.

Good Morning Lodge!

 

[St. Clown]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Morning.

The wife has approved a MN state fair trip this year. Likely it will be on the last weekend as that is already a long one due to the holiday.

I will be there for the Weird Al concert this year. I'm not sure if I'll be there any other days. My wife likes to go almost every day it's open, even just for a couple hours in the evening, if she can swing it. Things are a little different this year, so that remains to be seen.

 

[Greyeagle]

Re: Rep Retirement Lodge 201: A State You Don't Expect

The boss and I are going on an Alaska cruise at the end of August plus a pre-cruise Denali deal and a couple of extra days in Vancouver on the back end. This will be the first time Mrs. GE will miss going to the fair. Ever.
Granted she grew up (and her mom still lives) between Como Park & the Fairgrounds but still....that's a heck of a run.

 

[Swansong]

Re: Rep Retirement Lodge 201: A State You Don't Expect

It is structured to fail. Used to be discharge planning was a huge focus of the nurses' job. Then, with the roll 'em in and roll 'em out fast as you can mentality, this has almost totally disappeared. No longer a proactive approach but a reactive one. Mind boggling to me as a good discharge plan forestalls all sorts of over utilization afterwards and the way reimbursement is structured they lose cash if the person is readmitted.

Good Morning Lodge!

Well, I think the intent was that the slashing of payments to the hospital for re-admissions would incentivize the hospital to plan the discharge in such a way as to reduce the chance of said re-admission. And the CCMs do a lot of work with the discharge planning. Unfortunately, that usually starts and stops with "discharge to SNF" or "discharge to home". The bulk of their time is utilization review and making sure insurance/Medicare approve treatment so they get paid. Once the patient goes to a rehab or nursing facility they're no longer the hospital's problem, and once they're discharged to home the hospital absolutely does not have the resources to follow up beyond - maybe - a token phone call. CMS has been pushing states and hospitals to adopt the ACO program (Accountable Care Organization), but short of that there isn't much follow-up. And ACOs aren't everywhere, are only for elderly that meet certain narrow criteria and aren't mandatory. And not to get political, but when you have like 40% of the country screaming "OBAMACARE SUCKS END IT ALL" and 40% screaming "NO ITS PERFECT DON'T CHANGE A THING" you get ... this...

My hospital is an ACO hospital, so I know our elderly patients are at least monitored. The last hospital my mother was admitted to is similarly an ACO facility, so I spent some time with the assigned case manager and social worker. But even their staffs are overworked. In most of their cases, if the patient is receiving any kind of institutional care (in facility, home hospice, etc), their work consists of a bi-weekly phone call and maybe 1-2 in-person visits. I don't know if they pay more attention to ACO patients who don't have that level of care.

 

[Scarlet]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Back from my post op. Big, honkin’ cast is gone. Replaced by a bigger, heavier boot! Seriously, I can barely move it. The last couple of days my heel has been hurting. Turns out one of the incisions is on my heel and that’s what hurt. It stings. A lot. More now. Not much they can do about it. When they took off the cast and bandages, it was bleeding. So they re-wrapped it and put a cool ace bandage and then the boot. No new cast. But this boot, man, it’s tight and heavy. And has one of those pump mechanisms like those Reebok sneakers from years ago. At least I can remove the boot when I go to bed.

They were pretty happy to see how it looked. It’s swollen but not a lot. I go back July 1 to get the stitches taken out. Hopefully they’ll allow me to put weight on it at that point. Maybe not. They were also happy and impressed that I stopped the Oxycodone so son. Gave me the ok to start taking Advil now. Took two in the car one the way home. And now, even though I can’t put any weight one it or get it wet, I can take a shower. I bought one of those cast covers to use. Thank God.

So, I asked if they were in touch with the short term disability case manager, he said no. Huh?? In the car on the way home, I called them and the woman was like “OMG, no one called? I see here that there was a task listed to contact you on June 17. No one called?” Um, no. And my short term disability was supposed to have started on the 19th. So she retroactively got it to start yesterday and to end on July 21. No questions. I could’ve said make it two months. How annoying is that? The. She said “when is your post op appointment?” I told her I had just left there and that’s how i found out no one called. Told her I was going back on July 1, she said they would reach out the week of July 8. Thank God I called because I might not have been able to get paid. Annoying! ::shakes fist::

 

[Swansong]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Jebus that's frustrating.

Regarding your actual foot - isn't it incredible what our bodies can handle and recover from?

 

[leswp1]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Well, I think the intent was that the slashing of payments to the hospital for re-admissions would incentivize the hospital to plan the discharge in such a way as to reduce the chance of said re-admission. And the CCMs do a lot of work with the discharge planning. Unfortunately, that usually starts and stops with "discharge to SNF" or "discharge to home". The bulk of their time is utilization review and making sure insurance/Medicare approve treatment so they get paid. Once the patient goes to a rehab or nursing facility they're no longer the hospital's problem, and once they're discharged to home the hospital absolutely does not have the resources to follow up beyond - maybe - a token phone call. CMS has been pushing states and hospitals to adopt the ACO program (Accountable Care Organization), but short of that there isn't much follow-up. And ACOs aren't everywhere, are only for elderly that meet certain narrow criteria and aren't mandatory. And not to get political, but when you have like 40% of the country screaming "OBAMACARE SUCKS END IT ALL" and 40% screaming "NO ITS PERFECT DON'T CHANGE A THING" you get ... this...

My hospital is an ACO hospital, so I know our elderly patients are at least monitored. The last hospital my mother was admitted to is similarly an ACO facility, so I spent some time with the assigned case manager and social worker. But even their staffs are overworked. In most of their cases, if the patient is receiving any kind of institutional care (in facility, home hospice, etc), their work consists of a bi-weekly phone call and maybe 1-2 in-person visits. I don't know if they pay more attention to ACO patients who don't have that level of care.

From what I thought I knew the hospital eats any readmits (global fee) if they are readmitted. It seems to have changed nothing. They are willing to roll the dice. They also are ridiculous about readmission and will hold people in the ER, repetitively see them and send them home rather than re-admit.
We were involved with the ACO- it was a scam to reimburse as little as possible for anything. They made the measures close to impossible to meet or if you met one it meant you probably couldn't meet another. Most of the Docs attempted to opt out because it punished you if you took patients who were non-compliant (same thing for the tiering thing- if you are willing to take complex or non-compliant patients all you patients suffer because the code you higher)

Back from my post op. Big, honkin’ cast is gone. Replaced by a bigger, heavier boot! Seriously, I can barely move it. The last couple of days my heel has been hurting. Turns out one of the incisions is on my heel and that’s what hurt. It stings. A lot. More now. Not much they can do about it. When they took off the cast and bandages, it was bleeding. So they re-wrapped it and put a cool ace bandage and then the boot. No new cast. But this boot, man, it’s tight and heavy. And has one of those pump mechanisms like those Reebok sneakers from years ago. At least I can remove the boot when I go to bed.

They were pretty happy to see how it looked. It’s swollen but not a lot. I go back July 1 to get the stitches taken out. Hopefully they’ll allow me to put weight on it at that point. Maybe not. They were also happy and impressed that I stopped the Oxycodone so son. Gave me the ok to start taking Advil now. Took two in the car one the way home. And now, even though I can’t put any weight one it or get it wet, I can take a shower. I bought one of those cast covers to use. Thank God.

So, I asked if they were in touch with the short term disability case manager, he said no. Huh?? In the car on the way home, I called them and the woman was like “OMG, no one called? I see here that there was a task listed to contact you on June 17. No one called?” Um, no. And my short term disability was supposed to have started on the 19th. So she retroactively got it to start yesterday and to end on July 21. No questions. I could’ve said make it two months. How annoying is that? The. She said “when is your post op appointment?” I told her I had just left there and that’s how i found out no one called. Told her I was going back on July 1, she said they would reach out the week of July 8. Thank God I called because I might not have been able to get paid. Annoying! ::shakes fist::

Yikes!

 

[The Rube]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Morning.

The wife has approved a MN state fair trip this year. Likely it will be on the last weekend as that is already a long one due to the holiday.

I usually go that last weekend. Most have gotten it out of the way, so usually smaller crowds, depending on weather. I'm in at 10am or so, out by 3ish, when and if the crowds start to swell.

 

[MarkEagleUSA]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Good morning to tLodge!

 

[mookie1995]

Re: Rep Retirement Lodge 201: A State You Don't Expect

s'upp y'all

 

[Ralph Baer]

Re: Rep Retirement Lodge 201: A State You Don't Expect

Good Morning, MEUSA!
Good Morning, Mookie!


Good Morning to the rest of tLodge!

 

[Swansong]

Re: Rep Retirement Lodge 201: A State You Don't Expect

From what I thought I knew the hospital eats any readmits (global fee) if they are readmitted. It seems to have changed nothing. They are willing to roll the dice. They also are ridiculous about readmission and will hold people in the ER, repetitively see them and send them home rather than re-admit.
We were involved with the ACO- it was a scam to reimburse as little as possible for anything. They made the measures close to impossible to meet or if you met one it meant you probably couldn't meet another. Most of the Docs attempted to opt out because it punished you if you took patients who were non-compliant (same thing for the tiering thing- if you are willing to take complex or non-compliant patients all you patients suffer because the code you higher)

Yikes!

Hospitals often hold patients in the ED because they don't have available beds, too. My hospital is almost always full, so it's not unusual for people to have to wait. Fortunately our ED is tiny so we don't get a ton of issues. UMASS Worcester, however, is different. You may wait your entire admission in the ED as a boarder, depending on acuity and availability of required beds. If you're just admitted for observation, this doesn't matter much other than it being more difficult to visit someone in the ED than on a floor. And, obviously, the ED Staff hates it (not to dismiss their opinion - treat your staff well!).


ACO has changes rather significantly over the past few years. Believe it or not, my hospital recaptures a ton of money from in (I just asked the analyst that manages the patient registries - we're one of the "best" in the state for it). It's a great concept that, most likely, was total garbage in its infancy. The issue is definitely with compliance, which is why they're supposed to follow up (at least) with the CCM and SW. But it still comes down to the patient and/or family at a certain point.