Health Care in Flux – Again

English: Electronic Health Records flow chart.jpg
English: Electronic Health Records flow chart.jpg (Photo credit: Wikipedia)

Healthcare is in flux again.

I work as a night shift float RN; I qualify to work ICU as well as all the “zones” in my hospital. The only place i’m not comfortable is babies. And I don’t need to work there unless they are in a real bind and then, I will be a helper, not take patients.

Sunday night I was on surgical. Sure, it was Sunday, a day traditionally without many surgeries, but still, the census was half what it was the last time I was there. Tonight, I’m on “ETO standby.” This means I stay available to come into work till 11;30 PM. Since I’m writing this at home, I didn’t get called in.

The census dropped dramatically. This is not a normal low census time and yet, over the early to mid summer, we saw a drop and now, with ACCRA struggling out of the gate, we again are seeing more fluctuations than normal. I read of nurses being laid off. NURSES! Those of us who are baby-boomers are coming on strong and yet, we are being laid off.

The last really huge fluctuation I remember in census and my hours being affected was DRGs. DRG is Diagnostic Related Groups. As a speaker I recently heard said, “it was the end of health care as we know it.” Sure, things changed but for that first summer, I took lots of vacation days because my hospital and others didn’t know what to expect.

I presume a similar thrill is threading through providers today – insurances are cancelling on people, maybe some are covered but until the end of March 2014, we won’t know squat. CMS, the Medicare/Medicaid part of the Fed. Govt., is no longer paying fee for service, but pay for performance – and we need to perform and prove through out care but even more so (sadly but necessarily) through our documentation.

And don’t get me started about electronic records. Sure, I like charting on a computer but reading paper records spit out by someone else’s system is crazy, plus, systems don’t talk to one another. I heard hope by the same speaker above from Apple, working with two very large medical records firms. I hope so.

Too bad they weren’t brought in for ACCRA.

BTW, I don’t mind being home tonight and the heat cycles, noted in previous entries, is ending. TBTG.


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