Tuesday, November 16, 2004

Charge Back

The medical center must learn to compensate for its underprivileged status in the county bureaucracy. Dave Kears, much like George Bush, has pushed a privatization model on county health services. Non-profits, the medical center, and for profit healthcare providers all compete for limited county healthcare dollars; instead of cooperating to provide coordinated care. So if a mental health agency can drop off an alcoholic for a week or two at Highland and then let the medical center find them a place to live, it makes their bottom line look good.

Here’s a hypothetical you’re a private hospital administrator with a problem patient: she needs a nursing facility, she’s too young for Medicare, she has multiple sclerosis, she can’t walk, she’s incontinent, she has bedsores and psychiatric problems (which she refuses to treat.) She’s sitting in your thousand dollars a day hospital bed screaming and scaring your paying clients with non-stop profanities. In an effort to manage her screams and complaints her doctor has her on enough morphine to knock out a bull elephant and of late she’s taken to throwing food at the nursing staff and talking about suicide. Then she does you a big favor, she jumps out her first story window and sustains some scratches landing in the bushes below. In a stroke of administrative genius, it occurs to you, this is your opportunity. You dial 911 and when the ambulances arrive you tell them she is a trauma victim and have them take her to Highland. Patient dumping or appropriate triage, you be the judge?

Enough speculation, it suffices to say many clients with complex needs and problems miraculously end up in the medical center. This occurs in spite of private and public mental health services, adult protective services, the county conservator, Telecare, Regional Center and more. We have an enormous number of poorly coordinated county services and contractors. Somehow problem clients from all sorts of county funded services end up at the medical center in bad shape, at this point it falls on the medical center to fix not just their medical problems, but also their social and economic problems. The hospital has to get them well and get them a place to live. These patients sit in the hospital for weeks to months, until medical center’s social workers can find them a place to live with an appropriate level of care. These clients get put on administrative days (Medi-Cal won’t pay for their stays) so the medical center eats the costs.

So county agencies, private hospitals, non-profits and for profit providers all dump their “problems” at Highland. Once these clients end up in Highland the medical center must find them a place to live. At the end of the year county contractors receive “fiscal rewards” for providing cost effective services and the medical center gets to booby prize for spending too much on the sick. So what is to be done, well Cambio Healthcare Consulting could use a tool frequently employed by our corporate cousins, the “charge back.” This is a sound business move and since county healthcare services are based on competition instead of cooperation, it’s a smart defensive tactic. If the CEO of the moment kept records of all the costs incurred by medical center clients who are supposed to be managed by other agencies they could “charge back” these costs to the county at the year’s end and demand their “fiscal reward. “

1 comment:

Anonymous said...

Hey, has anyone noticed Highland is in complete disaray?
Wow, what a surprise!! NOT. When quality patient care is not a priority eventually they notice. I'm surprised JGP did well since a patient admitted there recently was not searched and had suicidal ideations. How would that have looked if that patient overdosed or cut their wrists with contraband that wasn't identified on admission? I guess they got away this time. Maybe it was that extra 900 thousand dollars we paid that seperate consulting firm. I am shocked HGH nursing got dinged again. You would think that with all the money we spend on those registry and travel RNs would have paid off. Oh, I forgot they aren't tested for competency before they get a patient assignment. Who cares if they don't care about doing all that paperwork. They have an RN after their name so they must be qualified. Should we really split hairs when they give their meds late or better yet not at all. And do lab values really count at the end of the day if they aren't acted upon? Why sign off your MD orders, that is such a hassel and you may never go back to that floor again. So what if all the orders don't get done. At the end of the day we got all those ER patients a bed. Does it really matter if we increase their length of stay or better yet kill a few patients? Well my answer is HELL YES IT MATTERS!!!!! What in the hell is Cambio doing? I know, a whole lot of lip service but little else. We must regroup for this fight!! We must not adapt or turn a blind eye any longer. We must stand up and refuse to enable our so called leaders as they dismantle our medical center one person at a time. Perhaps a class action lawsuit for not providing a safe work environment would get their attention? Maybe more surprise visits from CMS will work. We must go to any lengths to protect our patients and ourselves. I'm game. Anyone care to join me?