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  1. J

    Fines for readmit patients and EMS

    The other measures being looked at include stroke, hip and knee replacements, stents and CABGs. CMS is concerned now about reducing hospital readmissions. CMS is Medicare, Medicaid, and the State Children's Health Insurance Program. At this time I don't believe the private insurers...
  2. J

    Fines for readmit patients and EMS

    You also must understand the reasons why CMS had to impose the DRGs in the 80s. You yourself on this forum have said alot of testing done was not necessary. That is what CMS stated over 30 years ago when hospitals and doctors were profitting by ordering as much as possible and keeping patients...
  3. J

    Fines for readmit patients and EMS

    This is not about your chronic "offenders" from the street who use the ED like a revolving door. That is another issue to address but CMS readmission penalties that went into effect yesterday are rather clear. Hospitals have been monitoring AMI, CHF and PNA patients for a few years to...
  4. J

    Memo:

    True. And if the patient can get to the hospital comfortably with only minimal interventions, I'm all for that. The scenario Smash gave was in a controlled environment with what seemed to be an obvious end of life presentation. Many won't be and some patients look really sick but will live...
  5. J

    A-Fib then and now?

    1. Baby boomers and the aging population 2. Increased obesity 3. Increased media sources to make data available. Now you can get it on a snipet on Yahoo rather than going the library and looking up the stats. 4. And, what Mr. Conspiracy said.
  6. J

    Memo:

    Cancer is not always a death sentence and there are other reasons for a ventilator. Sometimes doctors also have to get over their stigma about certain patients and treat. Some just have to hear the word cancer and immediately write the patient off before hearing the rest of the story. Having...
  7. J

    Memo:

    I have seen cases where one day the doctors are going all out giving the family lots of hope and then the next day a more exciting patient is awaiting transfer so it is a quick change in attitude and the patient is made comfort care with a very confused family kicked out of the unit. As the...
  8. J

    Memo:

    It depends upon the reason for the ventilator. Someone with a lung CA may not die today or even 3 years from today. If they had a hospital caused fluid overload, do you not treat? You are going to find these decisions are not as easy as you think. To allow a patient who might have many...
  9. J

    Memo:

    Without knowing any details, no one can side with you. Just not wanting to admit another patient is reason enough for some and turfing the patient to pallative care seems easy. Actually it is not always that easy. The physicians must be properly consulted since "pallative services" is not a call...
  10. J

    Memo:

    Not all patients who "need a vent are terminal. Any DNR patient can also be placed on a ventilator if deemed to be a reversible situation. All patients (or people in general) are terminal. You also have to consider the families wishes. If the patient is already with a "terminal"...
  11. J

    How often should you take vitals on a critical patient?

    The machine does not care if the patient data is stabilizing. It is going to give you a number based on the algorithm in the machine. The number you get is an average of usually 3 second. If perfusion is low, it may take a little longer to gather the data set by the algorithm parameters. This...
  12. J

    How often should you take vitals on a critical patient?

    The quantitative value does not take a minute but for perfusion accuracy the number you are looking for will. Usually the value will be a 3 second average much like the ECGs. Sometimes it is easy to see the delay on the pleth in the ICU by palpating arrhythmias and watching the pleth. Some...
  13. J

    Fines for readmit patients and EMS

    Length of state as concerns for CMS is whether it was increased due to nosocomial infections. In most situations there is no benefit for the hospital to keep a patient longer than necessary or to drag out a patients stay. CMS and other insurances may already have an argreement that x is paid...
  14. J

    How often should you take vitals on a critical patient?

    Definitely agree. Masimo and Nellcor both have stated there is a delay in their literature. The interface and the software used will make a difference.
  15. J

    Fines for readmit patients and EMS

    Right now the issue is with hospital readmits where CMS gets heavily involved for reimbursement. CMS has been tracking the 30 day hospital readmit for a long time. CMS has cut reimbursement for many community and home health services over the past 10 years. Funding has dwindled to almost...
  16. J

    Oxygen 'therapy'...

    Martyn, the OP to whom you were replying to directly concerning O2, lists a place in the US as his residence. Would it be nice to know what the tank is capable of and the equipment with it if you had to use one? You shouldn't have to waste time "figuring out" or surprised. It is good to...
  17. J

    Fines for readmit patients and EMS

    What QA monitors has your hospital been doing? Those are the ones CMS is mostly concerned about. There are many patients in the ER which CMS will not have much control over nor will those patients be covered by any insurance either state, private or federal. LTC facilities and hospitals are...
  18. J

    Oxygen 'therapy'...

    Are you talking about Nitrox for diving? That is a very special type of diving. Compressed Air is normally used. The FDA rules on Emergency Oxygen can be applied anywhere in the US. The definition of Emergency Oxygen has been in effect since 1996. You can contact the ARC for more...
  19. J

    Oxygen 'therapy'...

    What type of diving are you doing with an Oxygen tank? Medical grade oxygen requires a special permit to purchase. Welding oxygen is not medical grade. http://www.diversalertnetwork.org/training/oxygen/oxygenfills.asp I have yet to see a dive boat have a problem getting their...
  20. J

    Is a EMT-B higher then a CNA?

    One doctor's opinion. An EMT can work ortho if they can be cross trained as an ortho tech. If the facility is not large enough to support this, they must be a CNA also. Usually it is the CNAs who are chosen to be cross trained since they are already working the ortho unit and are already...
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