Thursday, July 30, 2009

More From Emailings....8/5

Emailed to me, subject: Congressional Clout

This is an awful lot of reading. Some of us will just go with the flow. But, read some of the provisions and compare them to the language of the actual bill (attached). Or go through and pick the ones that piss you off—and verify them.

Then, write a letter (a real one, not an email, not an on-line petition—they get round-filed) to your congressman (the link will take you to where you find out who yours is.) You can say that you’re mad as hell and that mad is going to stay around through the next election. Cite the provisions that bother you. Get your spouse to sign as well.

Think about this: There hasn’t been a President elected from an independent party in recent history. Too much stacked against them. But, Congress is a different story. And the weight of the independents when the two major parties are deadlocked is significant. More actually than a long-term incumbent.

Maybe we do need to make a change, but I want to know that my representatives are aware of the provisions and can vote intelligently—like we supposedly did when we voted them in. Passing a bill with only the vaguest idea of what it contains is not responsible. Too many people respond to the “this won’t last long in this market” and “if you snooze, you lose.” ***

This is a bill that we have no idea as to what it is going to cost. No one does. Yet. The time to find out the cost is before it passes. This is the time for competitive bids.

Or don’t feel so superior when those people who bought houses for which the payments are more than their total income are paraded on TV. You’ll be one of them.
The included listings of specific hot-button items is in comments. The post would have been far too long. You can download the bill from the previous post's comments.

*** I would include, "And Congress responds to, "We have to pass this NOW!" Less reading."

And, another chipped in:

Yes, healthcare for the elderly will be seriously ... Yes, healthcare for the elderly will be seriously limited. Tests and surgeries deemed too expensive will not be allowed.
Can euthanasia clinics be far behind?
And yes one congressman did state that the healtcare bill was too long to read and he didn't need to read it anyway. Now I ask you, if someone handed you contract filled with fine print and clauses would you just sign it? Or would insist on reading it and having your lawyer read it too before you signed it? Yet that is what Obama is asking congress to do. Sign it into law without knowing what's in it. Obama has even admitted he hasn't read the damn thing. Who's driving the bus??
I urge everyone to email their congressmen and senators while they are on recess. Let them know this healthcare bill is not what you want!!!

I admit, if someone dropped a 1000+ page contract on my desk, I'd want some serious review done. Either by myself, or by someone with my interests at heart. We don't have that here.

An added inclusion, submitted in a comment, but since it doesn't display there, I thought I'd bring it forward.
Frank, check out Pg932-6 and see how this applies:

Thursday, July 23, 2009

80% Believe....7/31

The latest figures indicate that Congress should come under whatever health care program that the citizens are being forced into. Is 'forced' the correct term? Possibly not, but there are reservations--from physicians, from health care workers, and from citizens, as well as Congress itself.

What are those reservations?

  • Cost

  • Ability to keep what some already have.

  • Congress being lax in reading the 1000+ pages of the House bill.

  • Congress's adamant refusal to come under the provisions of the bill.

  • Taxing employer provided health care (didn't they criticize McCain for that proposal?)

  • Forcing out the commercial policies.

  • Possible federal mandated restricted care (MRIs, CTs, and C-sections are what were touched on. Probably more to come.)

  • Exaggeration of the numbers of the uninsured.

  • Who is going to pay for it?

  • If you are going to limit costs, are you going to enact tort reform (litigation is a major source of medical costs?)

  • Limiting treatment to those with terminal YOUR parents, or you.

Fewer applications to medical schools might be fortelling the future. One reason is the overwelming amount of paperwork mandated by the federal government. And you think it'll be less???? We've been depending on FMGs (Foreign Medical Graduates) covering the rural and inter-city areas. What happens to their incentive to stay if the Fed gets involved to this extent?

Saturday, July 18, 2009

Change, But Can We Live With It?....7/26 interesting word. We've definitely had change in Paris.

But, we're talking about the Federal Government--managing 1/6 of our Gross National Product. This is the same government that has yet to come in under budget on almost anything?

This is the same administration that said they didn't understand the severity of the recession?

The same administration that let Billions in pork get attached to the stimulus package.

This is the same administration that wants to include 10+ MILLION illegals in the care process....because if they're citing the justification for 50 Million uninsured, they're part of that number.

Of course, that also includes those young adults that are not covered--by choice: those healthy enough to roll the dice, and mostly win. That's an extra latte a day.

That also includes those that are counting on the guaranteed access to emergency treatment, reguardless of ability to pay, that already exists. They are estimated at 18 Million, with many over the $50k income level.

So, what happens when the government runs hospitals? Take the VA...look at Walter Reed. One of the formost military hospitals...and what was it that they were having problems with? Oh yeah, patients falling through the cracks. Almost literally, since there were holes in the floors and walls.

So, if these patients are heroes, what's in store for the rest of us????

I'll consider making that change...when Congress makes the same one....

Friday, July 17, 2009

Ideas Wanted....7/26

From the comments:

OK,OK,OK, I get have a situation with medical care in Paris,Texas.
I have been reading this blog for 2 years and HAVE NOT ONCE heard of a solution. This country is full of whiners and finger pointers. Come on people, step up and put some backbone in it and solve the problem. I am a physician and have watched things fall apart. I cannot agree more that the Big Boys snookered the "ownership" of the not-for-profits and sold you down the river.

OK, now for the solution....take back control of your destiny. It is too expensive to "buy back" the facilities that exist with dwindling profits and ownership is now private (not subject to oversight). You need a new facility with options for inpatient care and cooperation with a larger facility for transfers. You need a robust outpatient facility for the majority of ambulatory care. Allow the hospitals to carry on with their "for profit" management and they will soon learn that Paris no longer "needs them". Once this occurs, the doors to the meeting room will fly open.

Anonymous said...
"OK, now for the solution....take back control of your destiny. It is too expensive to "buy back" the facilities that exist with dwindling profits and ownership is now private (not subject to oversight). You need a new facility with options for inpatient care and cooperation with a larger facility for transfers. You need a robust outpatient facility for the majority of ambulatory care. Allow the hospitals to carry on with their "for profit" management and they will soon learn that Paris no longer "needs them". Once this occurs, the doors to the meeting room will fly open."

best idea i've heard yet, doc. how do we make this happen?

I'd like to say the county could come up with something at this point, but truth is, some of those physicians that have been "reading this blog for 2 years and HAVE NOT ONCE heard of a solution" need to step up and become players again. (The blog has been here for three, and there have been suggestions of that nature....)

Yes, I know your retirement investments have been sorely depleted. Yes, I know that Obama-care gives you chills. And, finally, I know that a struggle over the healthcare industry in this town is going to have some unpopular side-effects, but you know, sometimes the medicine just can't be sugarcoated.

Bemoaning The ER....7/20

Don't know if you caught the Snooze article on ERs.
Emergency room challenges

By Sally Boswell

Published July 12, 2009

We’ve all heard the horror stories.

A friend, a loved one, is injured or falls ill. They go to the emergency room at the local hospital and once there, are forced to wait — and suffer — an interminable length of time until they are seen and treated by a physician. In the most extreme versions of the story, the patient dies of neglect, sitting unattended in a chair in the emergency department waiting room, hours later.

Sadly, the story — at its base — is rooted in an undeniable truth: Emergency room wait times have gone up.

According to a report issued earlier this year from information gathered at more than 7,000 hospitals across the nation, the average wait time in emergency departments across the country went up to 4 hours and 3 minutes, an increase of 27 minutes since 2002. In Texas, wait times in 2008 averaged 4 hours and 8 minutes, putting Texas 31st in the nation in that ranking.

In August 2008, the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention and the National Center for Health Statistics, issued a report on the state of emergency departments nationally. The report linked patients’ inability to access a primary care provider in a timely fashion with the increasing frequency of ED visits. This was compounded by a decreasing number of EDs across the country as well as decreasing numbers of inpatient beds.

“EDs nationwide are under increasing pressure to provide care for more patients,” the report reads, “resulting in crowding and increased waiting times for minor illnesses.”

“What most people don’t realize is that the term ‘wait time’ is considered the total time spent in the ER,” said Chris Dux, CEO of Paris Regional Medical Center. “At this hospital, the total wait time is 3 hours and 10 minutes. The time from when a patient comes in the door until they are seen — not by a triage nurse, but by the nurse that is going to care for them — averages 42 minutes.”

“These numbers are just averages,” Dux continued. “Some waits will be much shorter, some longer.”

“The ER is not a primary care provider,” Dux said. “An ER is designed to treat medical emergencies. Patients with a true emergency will be seen right away. Non-emergencies, where there is no danger of loss of life or limb, no danger of bodily system failure, will wait while more critical patients are seen.”

“The reality is that the sicker a patient is, the faster they will get seen,” Dux said.

Many who complain about long wait times at the ER cite a lack of staff as part of the problem. Dux and other hospital officials dispute that claim.

“Our numbers show that our busiest days are Sundays and Mondays,” said Connie Murchison, CNO at PRMC. “and afternoon hours are the busiest. We try to anticipate the need and have appropriate staffing for known peak times, but there are never less than five nurses on duty at any time in the ER. And the nurses work overlapping shifts so there is no lack of coverage.”

“There are patients who get it into their minds that if they come by ambulance they automatically go to a room,” added Phyllis McDaniel, nurse manager of the ER. “That is not the case. Someone who comes in an ambulance goes through triage just like anyone else. They are assessed and if it is determined they do not have a true emergency, they get triaged back out to the waiting room just like everyone else.”

So what is the solution to increased wait times in hospital emergency rooms?

“To start off, every person, if they don’t already have one, needs to establish a relationship with a primary care physician,” Dux said. “If they have a chronic condition such as diabetes or a pulmonary or coronary condition, the physician will be familiar with their case. If problems arise, the patient should call their PCP first. The PCP can advise them if they need to go to the ER or if they can wait and come to the office the next day.”

“A physician’s office visit is also going to be infinitely less expensive than a visit to the ER,” Dux added. “It’s not cheap to staff an ER with physicians and nurses and therapists and lab techs 24 hours a day, seven days a week. People think, well, it’s the ER, it’s free.’ It’s not free. We’re going to bill you for it and we’re going to expect to get paid. Our doctors and nurses have to put food on their table as well.”

Calling a PCP first also has other benefits, according the Dux.

“The doctor may advise the patient to go to the ER,” Dux said. “He can call the ER and give them a heads up and instruction for the patients care when he arrives.”

“The PCP can also call the hospital and order the patient to be admitted directly into the hospital,” added McDaniel. “The patient can bypass the ER and all that expense.

Patients should bring an updated list of all medications when they come to the ER, Dux added, as well as a list of all allergies the patient may suffer. The patient should, if at all possible, never come to the ER alone.

“Bring someone with you who can see that you get home safely when you are released,” Dux said. “Someone who is in a position to act as your surrogate and can help the staff understand your condition and communicate for you. However, the patient should not be accompanied by a large group of people. There is a limited amount of space in the ER. There can be problems with issues of contagion and privacy if there are a lot of unnecessary people in the ER.”

PRMC is also implementing ways to help make wait times at the ER more bearable.

“We encourage people to make use of the hospital’s Wet Paris Clinic at 2224 Bonham St.,” Dux said. “We would like them to call for an appointment but if the show they will be seen. It’s also cheaper than a visit to the ER.”

“We are also making sure that our patients and their families are informed about the process,” he said. “If you know why you are waiting, it’s easier to wait, than if you are sitting there with no information.”

Dux noted that PRMC has formed an Emergency Department task force, consisting of Murchison, McDaniel and several staff physicians to examine process issues in the ED and look for ways to streamline the way patients are cared for. Hospital officials are also studying the use of rapid testing modalities, which can be done in the ER itself and make lab work faster.

“We want the people of this area to know that, according to the numbers, we are 20 percent better than most of the people out there,” Dux siad. “And we are working to get even better than that.”
I don't know, maybe their average is better than most...when you factor in the patients that arrive at 5AM....and in some hospitals, even 5AM is busy. Staffing needs to meet the needs of the customers, the patients...and when ER rooms are closed to patients because of staffing shortfalls, then one has to worry about management. And the West Paris Clinic isn't open on a lot of the peak times.

So pull up the intake statistics (that's what Meditech and computers are for, after all) and do some flexing. We'll get happier patients, and a happier staff, that's for sure.

Thursday, July 16, 2009

And Who Was Spotted In Nashville?....7/28

He's bigger than a breadbox....

Ego especially....


Awwww, you guessed it. Yep, Huddy was back in his town.

Job-shopping, perhaps? Hey, Hud, hope you got some good leads.... (Probably even updated his Linked In profile.... I could have said, '', but that would have been typecasting.)

Bet he just tapped one of his know, one of the ones he fired....and they got him right in. Networking at the highest level. Nothing personal, you understand.