Interesting article discussing the role of CMS in regulating hospital practices related to quality of care.
The conclusions don't bode particularly well for the future (self) enforcement and regulation of CMS and HHS transparency rules coming into effect now. Do any healthcare or hospital workers have additional insight or anecdotes into the effectiveness of CMS as a regulatory agency?
As I sat down to write this one particular assignment, an old folktale that my grandma used to tell me flooded through the gates of my memory. It might not be that good so, save your popcorn for the upcoming installment of Mission Impossible.
Once all the vital organs argued. Which one of them was the most important.
The eyes went "Well If I shut down, you all cannot see the beautiful world around you or stop before you fall off a cliff."
The ears went "Well If I shut down, you all cannot hear the beautiful notes of the numerous melodies."
The hands went "Well If I don't work… uh… you don't work at all!"
and so on.
Each of the organs had its compelling argument to win the debate. But it was all chaotic until a good old stomach joined in.
"Well If I don't work, none of you will last even a day."
All the organs laughed at the poor stomach and ridiculed him for being delusional. Until one day he stopped working. The eyes felt tired as the lids kept falling on them, the ears couldn't hear as strongly as they could and the hands weren't able to pick up anything because they lacked the strength to lift it.
And that's how stomach proved in one fell swoop, that how important he was.
Which I believe makes sense. Nearly 70% of the body's energy is spent in aerobic respiration. That is, breaking down the food we eat into small molecules and then extracting the energy from them so that we the big guys and gals can use them to hit the upvote button on Reddit. Therefore, it also is extremely important that we take care of such an important organ of ours. Because when the factory shuts down, the lights go off.
World Digestive Health Day, celebrated on 29th May, is a global initiative by health agencies all over the world to make sure the general audience is reminded not to take their stomach for granted. Just like our mobile phones, we need to keep them clean and functional. That involves eating greens, increasing the amount of fiber in our diet for better digestion and absorption of energy units, and course, putting less stress on it.
So, on this day let's take an oath to keep our stomachs clean and healthy or as Albert Einstein oh so generously said:-
"An empty stomach is not a good political adviser." ~Rudra
Me and my friend live in jersey.Almost 2 years ago my friend had surgery. She was diagnosed with gastritis and doctors found an area in her stomach lining that was being damaged. The surgery was needed to cut that part out. She didn't and doesn't have health insurance. At the hospital she went to she was able to get charity care. However That hospital didn’t tell her that the charity care was not gonna cover doctors fees. Ofcourse she had calls about billing but she notified them that it would take some time. Because of covid she didn't have her job anymore. Her husband is struggling to keep up with 4 kids, food and rent. And now her kidneys are starting to fail to the point where she has to go on dialysis soon. She's gone to a different hospital that has wayyy better charity care coverage. But that dept from the other hospital is still hunting her. She just received a letter in the mail that she is being sued for 15k. I've been helping out with with her medicine when I can. But im struggling as well. I've got a back injury preventing me from fully getting back to work. I know that she could file for bankruptcy but idk if that would actually help her more than hurt her. If anyone has any insight that could help her out please reply. The Healthcare system in NJ is full of shiii.
Over a billion people worldwide have sleep apnea, it goes undiagnosed in 80% of cases, and significantly increases the risk of developing and dying from the leading causes of death including heart attack, stroke, cancer, Alzheimer’s, diabetes, accidents, suicide, and more. In my opinion, sleep apnea is one of the most common, deadly, debilitating, and under-diagnosed conditions in the world. Hundreds of millions of people live out their lives a shadow of themselves, unaware that they have a treatable condition. At that, averaged out over decades, millions and millions of people die prematurely from sleep apnea. I'm overwhelmed by the aggregated mass of pain and suffering around the world because of the lack of awareness and the lack of readily available screening options.
It's time that we advocate for mass screening in the vein of mammograms or colonoscopies. Feel free to read and share my story below. Therein you'll find the research behind my claims.
I am 27 and my doctor wants me to get a endoscopy + colonoscopy, but my insurance won’t cover the procedure because I’m under 50. I make too much before expenses for hospital financial assistance, but with rent and student loan payments alone I really don’t make much and so can’t afford the procedure out of pocket. So do I just…hope I don’t have cancer?
I was recently dismissed from my DPT program following my first year. I had some troubles in the 2nd/fall semester and ended up with 2 Cs in courses. One of the courses was a 4 hour course causing me to have 1 more C hour than A hours which resulted in my GPA following below the 3.0 requirement. I was placed on academic probation for the spring semester. I took this very seriously and understood the repercussions. During the fall I noticed some things related to lectures and studying that were uncharacteristic of me as a student. I went to a doctor and was diagnosed with ADD/ADHD and began daily medication in between the fall and spring semesters. The medicine helped a ton and I focused on what I needed to do to get my GPA up during the spring. 2 of spring the courses were based on a large amount of material from the fall in the courses I obtained Cs in so I had to devote a large amount of time in relearning material. I finished the spring with 5 Bs. 2 of them were within 2.01% of an A. I would have needed 1 A to fit the guidelines for academic good standing and progression, but was at a 2.97 warranting dismissal. I planned to appeal this decision on the basis of my condition because I truthfully believed in inhibited my full potential. I believe I could have prevented the Cs with the medicine and/or increased grades in other courses. I also had a 4 hour course in the spring that I was less than a full question on the final away from raising the course grade from a B to an A and even preventing probation and subsequent dismissal. I met with the dean of the school before my appeal to state my case so that I could see if I had a valid case to not waste mine and their time and as a way to show some initiative. My request for appeal was approved and I had a hearing with a committee appointed by the dean. I had my hearing and they recommended that my appeal be denied and upheld. The dean conquered. I just wanted to see if I could get some advice on what to do next. It’s always been a dream to be a PT but I just don’t know what to do next. I have multiple emails out to individuals within the program pleading if there’s anything I could do such as simply restarting the program, or if readmittance in the future is possible. I also am in the dilemma of my wife just finished her Masters and works at the same hospital as the DPT program I was in and if I would be accepted into another program I don’t want to force her to up and move. It’s a great job out of college and she has made a lot of sacrifices to this point so I feel as if she does not deserve that. I also don’t know what I should do in this time off.
I want to ultimately be a PT, but I don’t want to complete a Masters program for that goal and then not get into any schools after. I also don’t know what professional jobs and doors my bachelors degree (BS in Exercise Science) open that would greatly interest me. I was looking into various Master's programs. When researching I am taking notes if they are healthcare related, could benefit a PT application, offered online, or could open a large number of doors and avenues to use for a job if I do not peruse another DPT program. Some early findings and examples I have been looking at is the Masters of Exercise Science program at my 4 year college. It would help me with PT applications, but I feel as if it limits job opportunities by itself. I also don't know if I would be totally interested in the job opportunities it could yield. I have also looked at the Masters of Health Systems Administration at the same school as the DPT program. It's formatted online and offers flexibility for non traditional/part time students that are also working. The last example in my early research is simply a Masters in Business Administration from my 4 year college. It's offered on campus and on line. It is fairly broad and give me a lot of options.
That's where I am up. It sucks, but I am the only one responsible for all of it. It's been extremely confusing and just looking for some help and pointers to help me get going in the right direction. Any advice and recommendations would be extremely helpful and greatly appreciated.
Or are those bills somehow separate from the out of pocket max?
I live in Maine, but from Canada originally. I recently discovered that the CEO of MaineMed one of the larger non-profit hospitals in Maine, gets paid $1.8 million annually (and he is not a doctor), while his counterpart just across the border in New Brunswick, Canada in a similar sized facility/ gets paid around $300-400,000 (and he is actually an MD). Why does this happen? Hospitals in Canada are privately run non-profits for the most part, similar to many American hospitals, but why can't American hospitals keep the costs of their upper management down? Especially since there is no correlation to high management pay and hospital quality?
Make your insurance problems your HR department’s problems
Insurance companies know you are not their customer, your employer that contracted with them is their customer. You are a captive participant, you are literally the revenue generating product your employer has gifted the insurance company.
The insurance company has no incentive to provide you any “customer service..” you are not in a free market where you can just take your business elsewhere.
If working with insurance is a headache include your HR department on the emails. Take time off to work to go through insurance paperwork. Take disability until you are able to get those appointments 4-6 months out. Inform your HR department of every denial, prior auth, and long wait times. Let them know how it is affecting your ability to do your job.
Make it transparent to the insurance company that you are keeping your HR department in the loop. If you are getting the run-around, let the insurance company know you will be talking to your employer’s HR department about the horrible service.
Make it so yo your employer will consider changing carriers so the insurance company has incentive to get their shit together. The insurance company literally doesn’t care about you from a customer perspective. They do care if they lose a contract with your employer. All the premiums from all those employees disappear.
So I was wondering does anyone know the business rules for EDI 837? And also the business rules for connecting 837 to 835.
Yes I have the guidelines of how to parser the EDI's but they really don't talk about the rules of which claim and so on
I was nervous to ask this because i don't know if this would fit in here, but I need help from someone, anyone, because it is taking my life out of control
I'm a teenager in my senior year and my finals start this Wednesday, and I have been stressed out of my mind. This year has been the worst year of my life because of the comeback of past trauma, family issues, moving out of my home, lack of self-confidence, and the fear of leaving school and growing up. All this has been making me spiral down into a cycle of stress, fear and self-loathing, and I started stress-eating (more specifically chocolate), while not being able to compensate with exercise. I have this craving for chocolate 24/07, which has led me to start spending my money in candy, and buying more snacks hidden from my mom when I am shopping for groceries.
She is a pastry chef, so I have plenty easy access to candy. My obsession is leading me to stealing portions of chocolate based ingredients every time i have the chance, looking desperately in every corner of the house to find any sweets she may have bought for herself. She has been finding out that I've taken things from her and now she is mad at me (reasonably) and I feel like the most disgusting person in the world. The worst part is that I am fully conscious of my mistakes, I think time and time again about how I should change, but when opportunity strikes its like I lose all control over my conscience and my body moves on its own, and I only realize what I've done after I swallowed the candy, dwelling in regret. My mom works so hard for me and to pay my school, to make us comfortable (at least as much as she can) and all I do to pay her back is steal from her. She doesn't deserve this.
I am also struggling to do anything productive lately. I had 3 whole free days which i was meant to use to study for my finals but every time i sat down to do it I would move to youtube and mindlessly consume content until 6 hours or more passed, and I keep on lying saying that I'm studying to my mom.
The guilt is suffocating me and I am desperate to stop, but I don't know how since no matter how much i think about it, I cant make actions. I wanted to know any way I can remind/force myself to do things right? Anything works, I just want to stop being a disappointment and be the person me and my family need right now. Please help me.... if not possible, please recommend somewhere I can look for help (preferably without paying, I have no money and I can't ask my family rn. I am also not from the US, to make it clearer)
(should i just go to a mental health reddit instead, maybe? idk anymore...)
I'm a 16 years old man, my dad pays Oscar so I can be covered by an private insurance, what's weird is that I'm also registered in Aetna Florida, for some reason I am linked with the mother (96 years old) of my ex stepmom, so I thought that maybe it was because of her because I was her dependent for a long time. Last month I got my meds with a new addition, due to the change Oscar would cover everything up but I would need to pay an 86 dollars copay, while I was talking with the CVS cashier, he told me that I was also registered in Aetna so maybe he can look up if changing the insurance everything would be covered without a copay, it did. I talked about this with my ex stepmom thinking that she knew that me and her mother were in another insurance too, but she told me that she was in multiple jobs and I think the only full time job she had was at Disney but she quit a few months ago. I'm supposed to pick up my meds again tomorrow and I'm scared that if I use the Aetna insurance when I'm at the counter at some point we can get in troubles. Anyone knows if it is okay or what I should do. Thank you beforehand
Hi All,
My sister in law works in a local hospital, she does administrative duties there. One of them is to keep track of bed availability. At the moment she uses an excel spreadsheet that she inherited from previous employee. The thing is that it's not very efficient and to be frank, it's not very readable either.
She asked me to help her with the sheet and try to improve it for her. I was wondering though if there is any software that could help with it and was hoping someone here could point me to an existing solution.
This is very local small hospital somewhere in a rural Poland, the legislation here makes it a bit difficult to buy software (public auction requirements etc), so I was hoping to use something that is open source, ideally it could also be hosted locally (patient data confidentiality).
I did a quick search and found there is quite a number of hospital management open source solutions, but they seem to be very extensive in what they can do. We are looking for something simple, specifically to track the beds availability for two departments. She usually knows in advance when and how many children will be admitted and when they are supposed to be released (both the admission and the release date may change though). This is a hospital for children with special needs and often they are referred there by other healthcare units or schools etc. At any point in time she should be able to tell how many beds are taken / available at specific date. And ... that's pretty much it.
It doesn't have to be a software if truth be told, an excel spreadsheet that is efficient, simple and readable should be good enough too.
Many thanks!
A patient who has a Living Will that stipulates there is to be no artificial feeding to sustain life - all duly /legally signed, sealed and delivered and witnessed several years before.
Now in late-stage Alzheimer's and will not eat. In a facility that says they cannot accommodate the Living Will stipulations because they cannot just sit back & see the patient wither away (starve).
Guess it gonna end up in the courts - ??????????????
What do you think?
I'm in Texas and overwhelmed trying to make sense of the healthcare. I'm kind of right on the border between having medical issues but not qualifying for disability. Wondering if anyone can point me toward the right resources so I can understand my options?
I apologize if this is not the right place.
I have a prescription that is written for 90 tablets (one a day, every day), however, my insurance only covers 30 at a time so that is the most any pharmacy has given me. It has been 30 days, I requested a refill but it won’t let me.
The prescription is written for one tablet a day, daily, until next year. However, it says no more refills left, regardless if it was 30 days or 90 days, that would obviously still be way too early. All my prescriptions show up this way.
Is this an issue I need to handle with my insurance, the pharmacy, or the doctor? I don’t even know where to start, and it sounds like a mess.
If anyone could help me figure out where to start, that would be so great, or if this is easier than I’m convincing myself it is, please please let me know!
This is not a controlled substance, and the insurance and pharmacies do not let me get more than 30 tablets at a time regardless of the prescription being for 90.
I have been googling information for health insurance. I feel like there is a lot to choose. Its the first time I'll be paying for a health insurance and I dont go to the doctor oftenly. I am an electrician appreciate. My income is about 60k yearly.
Went to the ER in January. Left 2 hours later with a prescription for a laxative. Just got the bill today. $16,061.00 for the ER only, $1,546.19 my out of pocket expenses. I have the most expensive insurance offered by my white collar job and every insurance option I was given recently changed from a $500 copay to only discount ER visits at 80 or 90% depending on if you get the expensive or really expensive plan. My ER bill for a simple diagnostic was so high, I can't imagine if I actually got hurt or broke a bone.
"Insurance" it is not, it's really just become a discount coupon for a % off some astronomical made up number. The DR that visited me in the ER wasn't even in my room for 30 seconds and still billed me more than $1000. When confronted about that value the DR says "I don't make the rates" and when I call his office nobody in the Dr's office knows who decides the cost either. And this is one of the largest insurers and a plan through a company that has 10,000+ employees.
Has it become common to change from copay to % discount for ER services on other health plans?
(Based in USA) Long story short I work for a non-profit that assigns youth to spend time with the elderly in nursing homes, and I’ve been tasked with reaching out to all nursing homes in the region.
I want to know of the most efficient way in which I can grab a list of all of the emails of nursing homes in my county. Are there public health databases that would include this specific information? What are other creative ways I can find such a list?
Thank you all in advance!
Haven't had too much healthcare stuff done since having to get on my own health insurance.
I'm having a blood test done called Aldosterone: Renin Ratio at an in network provider. However it doesn't sound like it'll be filed with my insurance the same way like yearly physical blood work is filed. I have a $2,000 deductible.
Does anyone have any idea...ballpark...how much this will cost (LabCorp is where I'm going).
If i have a brush to scrub my hands with, or a wash cloth, does that make them cleaner than if i just rub soap and water on them?
I was seen in the ER Friday night and my After Care Summary contains a ton of information on physical exams that never happened.
The only people who touched me were nurses taking blood and checking blood pressure. Meanwhile there's notes on my pulse in the extremities, breath sounds, bowel sounds.
Further in they state I REFUSED iv/blood draw despite allowing 2 nurses to attempt access FOUR times. The doctor approached me while I sobbed in pain from the last attempt and I said "they tried 4 times and the last nurse was extremely unprofessional."
I'm getting more angry the longer I think about it.
I didn't start going to doctors / scheduling my own appointments regularly until the last year or so, and I'm still baffled by how long it takes to see anybody. A couple instances it took me almost a month to see my primary care, only to have them refer me to a specialist, and by the time I saw the specialist it had been nearly two months since I first noticed symptoms. I feel like I'm constantly playing catch-up with doctors. I've even asked to be put on wait lists for if earlier slots open up, but they never seem to. Has this always been the way it's been? Is it dependent on which health services / campuses I use?
I know this is a long text, but I really need advice on what to do here.
Here’s a short backstory; Some days ago I had to call an ambulance on behalf of my boyfriend (m23). He was in very severe pain and nausea for the first 2 days he was at the hospital. He has now been in there for 4 days and is much better pain wise but has still been deemed important, so he’s now waiting for an emergency surgery to take place. He’s been waiting for this exact surgery for 2 years and been living everyday with chronic pain.
My boyfriend (E) has been laying in the same room the whole time he’s been in the hospital, a shared 6 bed room with other people. I could finally come to visit him on day 3.
Now I’ll get to the situations that made me angry. Immediately as I sat down by his bed, a very loud laughter erupts from the opposite side of the hallway. Like a really annoying LOUD cackle, sounded as though there were at least 5 people. B said that it had been like that since the morning, also yesterday, and asked me to not complain and just be with him. The people laughing were nurses who either were on a 4-5 hour break (which seems odd??) or they simply had “nothing to do” and decided to sit in the lunch area and talk. I found it so incredibly distasteful and disrespectful that the literal nurses were just sat right next to a hospital room with patients and laughing (loudly).
The other patients in his room were of course not to blame for this (the staff were!) but they all had illnesses that made it very difficult for B to recover and do things such as sleep, eat and literally just exist. There were 2 old men that were constantly soiling themselves, making the room obviously stink which is the last thing you want when you’re nauseous. He couldn’t eat because of this. Didn’t eat for nearly an entire day. We’re talking at least 3 times a day each where the staff had to clean them and change the entire bedding. B had asked for another room (any room) 5 times, but always got the same answer; “no we cannot move patients right now.” During the time I was there on day 3, another old man was admitted. It quickly became clear that he had dementia. During the first day he was mostly just a disturbance (loud snoring, loud shouts, weird noises and being overly talkative) but yesterday something incredibly horrifying happened. Yesterday morning he began running off, thinking the was the doctor and not a patient, going through lockers and stuff like that. But then at 1:00 am i got a text that woke me reading “the old man opened my curtain just now and stood there in silence staring at me for at least 10 seconds before saying good morning to me.” Keep in mind that it was pitch black in the room. B obviously got incredibly scared, and being under the influence of morphine and other medicines just made the experience even more horrifying. B then wrote that he had told him that it wasn’t morning and to go away, causing the man to pace around the room and again- going through lockers. I basically ordered B to press the help button and make a nurse come in there ASAP. The man with dementia had now shat on the floor in the middle of the room. B demanded that they give him another place to sleep, and they said “okay we’ll move you after we’ve cleaned this” and drove B into a private room. It was suddenly THAT easy and there were at least 6 out of 9 empty or near empty rooms available the entire time.
A lot of other things happened, such as nurse being very rude and loud, using the button that controls all lights in the room, making it completely bright in the middle of the night (instead of just pressing the individual light) when fetching things from the cupboard, taking 1,5 hours to bring B a new shirt, etc.
But the fact that they put him in a room with patients who has these types of illnesses whilst the rest of the rooms stood empty was just so selfish in my opinion. It honestly seems like it was simply easier for the nurses to keep all people in one single room.
I live in Sweden, a country known for its modern healthcare. Am I in the wrong for finding this experience report worthy? Keep in mind that he was been waiting for a surgery for 2 years, and that his doctors have made a lot of mistakes, forgetting to inform him of things/call him or book him in for a routine check up and more. He has been forced to call and ask them for a blood sample, even though they were supposed to call him in ages before that.
I’m just so disappointed and angry!
https://www.wsws.org/en/articles/2022/05/14/vaug-m14.html
"The decision not to sentence Vaught to jail was greeted with cheers from nurses who gathered outside the courthouse. Nurses throughout the country are relieved that Judge Jennifer L. Smith rejected the vindictive demands of the state prosecution for up to eight years in prison.
At the same time, the prosecution and conviction of Vaught sets a dangerous precedent for the criminalization of medical errors. Vaught faces three years of intrusive probation, has not had her nursing license restored, and has suffered enormous personal and emotional consequences from the unjust prosecution, while still bearing the weight of the error itself and the life that was lost."