December 2nd, 2009 by Happy Hospitalist in Better Health Network, Health Policy, Opinion, True Stories
Tags: CMS, Incentives, Pay For Performance, PQRI, Quality
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It’s official. Happy has now earned his CMS physician pay for performance PQRI Bonus for 2008, a direct deposit into Happy’s bank account. PQRI stands for Physician Quality Reporting Initiative. How much was my PQRI Medicare pay for performance bonus for calendar year 2008? A $2,500 check written out directly to Happy by the Medicare National Bank. CMS gives a wonderful overview of the history of PQRI . PQRI is the Medicare pay for performance program for physicians that was initiated by Congressional mandate in the latter half of 2007. Doctors have an opportunity to earn back 2% of their gross Medicare collections (which the government calls a bonus but which I call legalized theft) by submitting a grotesque amount of quality performance paper work to the Medicare National Bank. It’s one giant PQRI guideline game.
PQRI reporting is currently voluntary, but legislation in future years will certainly mandate reductions in payment for not submitting data, all but making this program a punitive standard. Many physicians failed to meet the requirements to get paid under CMS pay for performance program guidelines in the latter half of 2007, the first year for PQRI measures. Read more »
*This blog post was originally published at The Happy Hospitalist Blog*
December 1st, 2009 by Bongi in Better Health Network, True Stories
Tags: Claustrophobia, Crowded, Elevator, Hospital, Hot, Physicians, Psychiatry, Surgery, Sweaty, Trapped
2 Comments »
A comment on my previous post by undead doctor, reminded me of another story about a lift in the old academic building in the old hospital.
Every morning all the registrars, medical officers and interns in the surgery department would meet in the boss’ office for a report on the previous night’s activities and to deal with whatever other administration had to be taken care of. After this meeting the day’s work would begin. The surgery department was on the seventh floor of the academic building. The lifts in that building were fairly small, so we did what any normal surgeon-type would have done in our situation…we tried to see exactly how many people we could cram into the lifts on the way back down after the meeting. As it turns out the lifts couldn’t take more than thirteen. I know this from the time we crammed fourteen into one lift and it got stuck between floor three and floor four. Read more »
*This blog post was originally published at other things amanzi*
November 30th, 2009 by Happy Hospitalist in Better Health Network, Opinion, True Stories
Tags: Bundled Payments, Exam, History and Physical, Hospitalists, Internal Medicine, Listenting, Psychiatry
2 Comments »
I remember very clearly as a medical student hearing my attending hammer home the importance of the history and physical examination. Everyday I heard the same thing
The history and physical examination is the most important part of patient care
After seven long years of hospitalist medicine, I gotta say my attendings were right. If you listen to what the patient is telling you, the answer is often staring you in the face. Unfortunately, in this volume driven world of fee for service we live in, time is not on the physician’s side. Most elderly patients are incapable of separating important medical information from irrelevant medical information, which can make history taking a very painful part of being a doctor. So they just talk and talk and talk. Read more »
*This blog post was originally published at The Happy Hospitalist Blog*
November 30th, 2009 by DrWes in Better Health Network, True Stories
Tags: Beeper, Cardiac Arrest, Cardiology, Code Blue, Computer, Hospital, Intercom, Internal Medicine, Pager, Running A Code, Technology
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Code Blue Then & Now…
Then:
11:30 pm – Cackling though the overhead intercom system:
“Code Blue, Three East, Room 236”
A thunderous herd of medical students, residents, anesthesiologists, cardiologists, social workers, security personnel descend on the scene. Arriving, the chief resident is in charge at the foot of the bed. IV’s have been started, some young well-muscled individual is bobbing up and down on the unseen’s chest, brow glistening with sweat, but focused. An anesthesiologist, noting the agonal rhythm, works to secure the airway, then a central line. Nurses administer drugs, bring line kits. Airway secured. “EKG? Where’s the EKG?” Electrode replaced. “Story? Who’s got the story?” Ten. Twenty. Thirty. The minutes pass. Finally, silence, as the monitors removed and the group departs. Like sound and fury, signifying nothing.
Read more »
*This blog post was originally published at Dr. Wes*
November 28th, 2009 by KerriSparling in Better Health Network, True Stories
Tags: Diabetes, Endocrinology, Finger Stick, Guillotine, Internal Medicine, Type 1 Diabetes
1 Comment »
Last week, on Twitter, Elizabeth Arnold posted a link to a photo that made my whole body cringe and I instinctively said, “Oh crap, THAT thing?” (I’m stealing and reposting this photo here, but the original photo credit belongs to Cardinal Health.)
Behold – The Guillotine:
This photo made me shudder because I remember this lancing device clearly. It was the first one I ever used, outside of having my finger pricked by the nurses with the lancet alone, and I remember the shunk sound it made as it came careening towards my fingertip. It wasn’t the standard shunk we know now – this sucker would have to be cocked back like a rifle, and once it clicked loudly into place, you had to hit that button on the back to release the spring-loaded lancet. And it wasn’t just spring-loaded – The Guillotine had an agenda. It would come screaming over the top of the curve and embed itself into your fingertip, and it was all my mother could do to keep my hand pressed against that little plastic circle at the bottom there.
I hated it. It scared the crap out of me, and even though more humane lancing devices were introduced soon after my diagnosis, The Guillotine lived in our house much longer than I’d care to admit. Even the lancets looked like little harpoons. Read more »
*This blog post was originally published at Six Until Me.*
