Weather Forecasting Accuracy Joins Medicare Value Based Purchasing Program.

Baltimore, MD  -  Just days after Medicare announced their historic timeline for shifting fee-for-service  to alternative payment models that focus on quality and value and just hours after New York meteorologists inadvertently shut down New York City with their failed Blizzard of the Century forecast,  the Obama administration announced the addition of weather forecasting accuracy to a value added payment mix used to determine how much doctors and hospitals are paid.

Bad weather forecasting now linked to Medicare penalties.
"After careful consideration, we have determined that doctors and hospitals should be punished for inaccurate weather forecasts that affect the safety and wellbeing of our Medicare seniors and we plan to hold them accountable," said HHS secretary Sylvia Burwell during a conference call with reporters.

New York public transportation was ordered shut down by New York Mayor Bill de Blasio after meteorologists predicted several feet of snow would wreak havoc on the city.  That forecast proved grossly inaccurate and upset millions of residents caught without a way to travel about the city.

Many New Yorker residents were thrilled with the federal government's call to action.  "It's about time those rich doctors suffered for these ridiculous weather forecasts day after day. Those people have no idea how hard it is to plan a day around bad weather forecasts," said Tom, an uninsured street vendor  who gets his healthcare from a charity clinic staffed by volunteer doctors and nurses on their days off.

By tying the accuracy of weather forecasting to payments, Medicare continues to push the envelope on creative ways to blame doctors and hospitals for failing to control costs.

Next week,  Medicare will publish their highly anticipated list of future additions to the value based purchasing program which is expected to include 2016 payment penalties tied to satisfaction with local DMV services and the availability of power scooters during peak shopping hours at Walmart.



Elderly Woman Admits to Family She's Not Really a Fighter.

Tuscaloosa, AL -  Ethel Burman shocked her family this week after admitting to them she wasn't really a fighter after all. Despite their insistence over the years, the elderly nursing home patient told her family she's never been a fighter and all their talk about her being a fighter is just made up gibberish in their own minds.
Son always requests WTF order:  Wants To Fight

"I just got tired of hearing my kids tell the doctors to do everything because I am a fighter and I snapped.  I'm not a fighter.  I'm 98 years old.  Last week I wrote a thank you card to my poop for being the only thing to show up on my birthday,"  said Ethel, who has suffered through debilitating illness at the nursing home for years.

Ethel is known hospital wide for her frequent hospital admissions to intervene on any one of her dozens of chronic medical conditions.  Ethel is part of a close knit group of frequent flyers being kept alive at all costs by their family's grit and determination.  "I've taken care of Ethel for years.  Her son always makes us write an order for Wants To Fight.   I say to the son 'WTF?' and he nods his head yes," said Angela Hanes, a veteran nurse who has seen it all.

Angela admits the nursing team on pod seven prominently displays a constantly updated list of WTF patients so nurses can mentally prepare for their day of pain.  "We have an agreement on the floor that if we are assigned a WTF patient, we don't have take anyone else on that day.  They require 1:1 cares all day long," said Angela.

Despite his mother clearly expressing her wishes, Ethel's son spent hours trying to convince hospital staff she didn't know what she was saying.  "My mother is crazy.  I'm her POA.  I know what's best for her," said her son with a straight face and exceptional insight.



Hospitalized Woman with New Complaint Everyday Diagnosed with Broken Furnace Syndrome.

Fargo, ND - Bertha Jensen was hospitalized two weeks ago for chest pain rule out, but a new complaint every day has prevented doctors from sending her home during the cold winter months.  That is, until a breakthrough in discharge planning was discovered by her current Hospitalist.

Consider Broken Furnace Syndrome for difficult winter discharges.
"When I was a resident in Minneapolis, I took care of at least a dozen cases of Broken Furnace Syndrome every winter," said Hospitalist Dr. David Penter, who is known for his uncanny ability to spot patients with ulterior motives from a mile away.

Broken Furnace Syndrome is any 12/10 symptom that presents during a patient-doctor encounter on the day of planned discharge from the hospital, followed by a completely unrelated symptom after the physician minimizes the first complaint. For example, having a 12/10 headache that is then followed with a complaint of diarrhea after the physician minimizes the headache complaint  is pathognomonic for Broken Furnace Syndrome.

Broken Furnace Syndrome occurs in the cold winter months when patients refuse to go home because of problems with their utilities or other social dynamics that have nothing to do with their hospital stay.  While often the result of a broken furnace, physicians should also consider variations of the disease in their differential diagnosis, including I Didn't Pay My Gas Bill, My Pipes Froze and I Don't Have Water and even My Mother-In-Law Is in Town and She Thinks She's Going to Stay With Me as the reasons for avoiding discharge.

Every time Bertha's doctor told her she was stable for discharge, a new complaint was suddenly described.  "We ruled her out for MI in less than 12 hours and 12 days later she's still laughing it up with the nurses, except for the three minutes the doctors are in the room, then she's complaining of 12/10 nausea,"  said Dr Penter.

A normal litany of complaints for an 88-year old has kept Bertha hospitalized for nearly two weeks, including headaches, nausea, chest pain, blurry vision, sore throat and restless legs.  On day seven of her observation stay, she even complained of diarrhea and constipation in the same night.

On day four of the observation stay, one hospitalist tried to put an end to the madness by spending four hours - on a Saturday - coordinating a stat laprobroncathoscopy between the surgeon, pulmonologist, cardiologist, gastroenterologist, anesthesiologist and pathologist, in anticipation of a Sunday discharge.  Despite everything coming back normal, her Sunday discharge was aborted after she complained of not having a ride home.

Dr. Penter confirmed the diagnosis by having his medical student stand outside Bertha's room all day listening to her phone conversations for clues.  This allowed Dr. Penter to get his work done while making the medical student feel important.

"We caught her taking to Dan the Furnace Man at around 3 p.m. yesterday.  When I presented my findings to her, she complained of 12/10 restless arms, followed by a lump in her throat that she wanted thoroughly checked out."




Am I a Good Parent? Two Question Quiz!

Many mothers and father often find themselves wondering whether they are good parents or bad parents.  The answer is really quite simple.   If you vaccinate your children and you don't spank, you're a good parent.   Good job parent!  If you vaccinate your kids but feel it's alright to spank them, you're a bad parent.  Stop it!  This flow chart diagram on parenting skills will help you understand.  Be a good parent.  Vaccinate your kids and don't spank them and you'll be a great parent.

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You can find many great books on Amazon about gentle parenting techniques that provide a positive experience for your kids.   The Happy Hospitalist is hoping 2015 will be filled with great parent experiences that bring joy to your childrens' hearts.  Fill their love tanks.  Say no to spanks and yes to vaccines.



Marijuana Doctors' Lounge at Colorado Hospital is Nation's First.

Denver, CO -  Brooks Hospital holds the honor of being the first and only medical facility in the country to offer a full service marijuana physician lounge and doctors say they wouldn't have it any other way.  Shortly after Colorado legalized possession of one ounce or less of recreational marijuana, the private physician area was opened at the urging Dr. Jeffrey Potter, a Hospitalist upset with the declining diagnostic skills of his fellow colleagues.

Physician smoking marijuana in doctors' lounge
"I was shocked at the number of H&Ps and consult notes that had 'heart problems' or 'vision changes' as the final diagnosis.   I knew a little marijuana could go a long way to improving the differential diagnosis skills here at Brooks,"  said Dr. Potter.

In 2012, the medical community was taken by storm when Dr. Potter diagnosed a case of Dilaudopenia and Polybabydaddia during his first hour on the job.  "That's the week I bought an ounce of Trainwreck," said Dr. Potter, who believes his smoking is protected by medical marijuana laws.

The revamped physician gathering area - known as the The Weed 'n' Feed -  was opened as a quality improvement project just weeks after Dr. Potter joined the staff.  "I knew I'd have no problem getting a pot lounge set up because every day I'd hear a doctor or nurse say 'What the Hell is administration smoking'."

The hospital's physician lounge comes stocked with a full assortment of marijuana flavors, colorful pipes, 4-way bongs and dozens of plants cared for by a different specialty every week, with the exception of Palliative Care.

"Last year we accidentally assigned cardiology and nephrology to care for the plants at the same time.   They argued for a whole week about how much water to give and we almost lost them all," said Dr. Potter.

Proponents of the unorthodox physician lounge point to a dramatic improvement in the diagnostic skills of medical staff members.    Doctors gather in the lounge at all hours of the day and night, taking hits and bouncing ideas off other physicians who often drop in during rounds for a mental boost on their difficult cases.

"Since the lounge opened, we've seen a 400% increase in our cases of Ridiculitis, Status Dramaticus and Terminal Fibrocryalgia, allowing our hospital to collect millions of dollars in higher fees for severity of illness adjustments," said Jane Wymore, Director of Quality Documentation at Brooks Hospital.  "And the average word count of our surgical notes has increased from 7 words to 15 words, a remarkable feat by any standard."

The Weed 'n' Feed Lounge has helped many physicians on the fence.  For example, ER doctors frequently visit the lounge to decide on a diagnosis of CHF vs COPD vs pneumonia.  "While taking hits with the Hospitalists last year, we discovered a combo pill called Lasofloxalbuterol.  The pharmacists told us it didn't exist, until we started inviting them to our lounge.  Now it's the most frequently ordered drug on our formulary," said Dr. Helen Smelter, an Emergency physician who almost had a heartastroke when the drug went on shortage last year.

For those doctors too busy to stop in the lounge, the hospital gives volunteer credit hours to pre-med students for transporting weed from the lounge to doctors and surgeons on the go.   "We even have one plastic surgeon who always takes a hit just before the opening incision to make the cut as cute as possible," said Jane Wymore.  "Her patient satisfaction scores are through the roof."

While most specialties have flourished, Jane says the orthopods continue to be the most challenging group.  "No matter how many hits they take, we still can't get them to write anything other than 'broken bone' in the chart.  In fact, we even had one unretired ortho doc write 'broken liver bone' after reading an abdominal ultrasound by mistake."

However, hospitalists are thrilled that orthopedic surgeons now come to the hospital at all hours of the day and night to admit their healthy hip fractures.  "Ever since the marijuana doctors' lounge opened, I haven't diagnosed a single case of Too Old To Admit To Ortho,"  said Hospitalist Jeffrey Potter.

Despite all the benefits, Jane Wymore says the hospital was not prepared for the unintended consequences.  "We had to triple the food budget in the doctors' lounge and put better locks on the doors after catching several patients in the lounge looking for fresh air.  And we upset a bunch of our medical staff when the chef said no to marijuana brownies."

"Lasofloxalbuterol:  When you just can't decide between CHF vs COPD vs PNA."


Lasofloxalbuterol.  When you just can't decide between CHF vs COPD vs PNA photo medical humor meme photo.