Hospitalist Group Starts Telemedicine Service to Get Paid for Answering Cross-Cover Night Calls.

Richmond, VA -- A Hospitalist Group affiliated with Chippenhammer Hospital has implemented a nighttime telemedicine service to get paid for taking cross-cover calls that should have been referred to a physician consultant instead.

"We were getting hundreds of calls a night,"  said Grace Jones, the new Director of In-house Hospitalist Telemedicine with Tired Hospitalist Group at Chippenhammer Hospital.

Hospitalist medicine growth has transformed the speciality into the path of least resistance.  Many doctors and nurses feel hospitalists should be called for all questions because they are already in-house.  Some hospitalist groups are even expected to field calls when other doctors don't answer.

"My job has become so ridiculous that I'll even get asked to call  a patient's irate physician daughter at 2 a.m. when we aren't even on the case!  We had to staff two hospitalists every night plus one more in the 20 bed geriatric observation unit just to field nursing calls while our one night hospitalist admitted 20 patients every night," Grace said while shaking her head in disbelief.

"To fund additional physician staffing, we had to figure out a way to get paid for fielding cross-cover nursing calls to titrate dopamine in a post-MI cardiac ICU patient or provide vent orders in a crashing ARDS patient, even though the order was to "CONSULT MEDICINE FOR DIET CONTROLLED DIABETES ONLY",  a written verbal order that was underlined twice and written in all capital letters at the request of the ordering specialist."

Tired Hospitalists worked tirelessly with The Centers for Medicare and Medicaid Services (CMS)  to get in-house hospitalist cross-cover calls paid for through telemedicine CPT codes by reducing payments to other physician specialties in a revenue neutral method.

"We analyzed all night cross-cover calls we received in the last six months and discovered 97% of all calls on patients with at least one consultant were inappropriately diverted to our hospitalist physicians.  As a result, we have instructed all hospital nurses to call our telemedicine answering service when at least one specialist is involved."

In addition to CMS payments, Tired Hospitalist Group plans to bill every specialty directly using proprietary software to determine how annoying the call really is.  Some specialty groups have expressed reluctance in paying a hospitalist to field their calls since they've been getting away with it for free all these years.

"I'm not paying a hospitalist to do my job.  If they don't want to take my calls, they shouldn't have become a hospitalist," said Dr. Wiley Scruff, a 78-year-old surgeon who hasn't answered his phone at night in 30 years.

After threatening to stop providing stat pre-operative H&Ps in patients with no medical problems, all surgical specialties agreed to pay Tired Hospitalist Group whatever they wanted.




Adrian Peterson Hired By Hospitalist Group to Discipline Noncompliant Patients.

Eden Prarie, MN -- Patient advocacy groups expressed outrage after a local hospitalist group hired Minnesota Vikings running back Adrian Peterson to discipline their noncompliant patients.  The NFL football player was charged with felony child abuse last week after reportedly spanking his 4-year-old child with a  "switch" as discipline for pushing another child off a motorbike video game.

Adrian Peterson mugshot.
"We tried to replicate his switch therapy on our own patients by using a tree branch whittled by one of our surgeons, but the results were dismal.  Mr Peterson's agent said he was available for employment so we jumped at the opportunity to bring his successful motivational techniques to our frequent flyers who feel empowered to ignore us," said Frank Fillmore, Director of Hospitalist Quality Improvement with Wisconsin Hospitalist Inpatient Program (WHIP) the largest hospitalist group in Wisconsin and Minnesota.

"In less than a week, his closed door consultations  have resulted in a two point drop in our average HgbA1-C and a  0.5 liter FEV1 increase in our COPD population.  Even more impressive, we haven't caught a single MI patient on a ballon pump with Kentucky Fried Chicken fingers.  It's nothing short of remarkable what he's done for our patients."

Hospitalist programs are often asked to implement creative methods for perfecting scores on numerous quality measures that determine how hospitals get paid by The Medicare National Bank.  Sometimes that means thinking outside the box.  The group of physicians say they hired Adrian as a last ditch effort after their hospital risked losing $100,000 out of 2 billion dollars in annual Medicare dollars.

"We were at our wits end.  None of our  patients would follow our instructions.  We tried being nice but that was just degrading.  We tried bribing them but they just took our money and ran.  When we heard of Adrian's remarkable ability to force helpless 4-year-old boys into fearful obedience, we just knew he was the man for our job," said Frank, who has since been promoted to Vice President of Interrogative Services with WHIP.

At first, the hospitalists weren't sure how the public would respond to a good 'ol fashion whooping on the frail elderly who can't remember to take all 42 pills three times a day as ordered.  But those concerns were put to rest after reading Facebook comments on the issue for several days.

"We were surprised to find the vast majority of people felt  it was okay to spank, helpless and defenseless 4-year-old boys who can't stand up for themselves against a bully.  The frail elderly are no different.  Now when families question why their 82-year-old one-legged diabetic mother has  14 lashes on her back, we say 'Your comment on TMZ says you turned out just fine after your parents spanked the crap out of you and you respect your elders just fine.  Your mother is acting like a child for not doing as we say.  We are confident this will help her respect us.'  It's WIN-WIN."

WHIP's spanking policy has been so successful, they plan to expand Adrian's proprietary therapy next week to the following patient populations:  Patients acting like children; Patients who bring adult children acting like children;  Patients who request a script for aspirin or Miralax so they don't have to pay for it;  Patients who demand being called doctor, despite having a Ph.D in art history; Patients who only admit to smoking two cigarettes a day;  Patients with a pan positive review of systems;   Patients with more than three allergies; Patients who take at least 100 units a day of U-500 insulin; Patients who stay against medical advice; Patients who call 911 from their room; Patients who go outside for some fresh air; Patients who answer their cell phone during an interview; Patients who ask when the doctor is going to be in;  Patients who are dressed and ready to go before the doctor arrives for discharge discussion.

"If all goes as planned, we hope to implement Adrian Therapy as part of our interdisciplinary discharge plan.  One study at a New Jersey hospital suggested kicking the crap out of patients just before they leave a hospital prevents a 30-day readmission 100 percent of the time, except for dementia.   We're still investigating alternative readmission prevention techniques for them."

CMS is keeping a close eye on outcomes from WHIP and is considering spank therapy as payable procedure using the 25 modifier code.




Dirtiest Places in a Hospital Top 10 List

What's the dirtiest place in the hospital you ask?   Is it the GI lab with their colonoscopy equipment and their C. diff?  Is it the operating room with their bowel obstructions, bloody gunshot wound victims, total colectomies and their spurting arteries?   How about the bronchosopy lab with all that MRSA colonization and gobs of spit.  The cath lab?  The radiology area?  The dialysis unit?  How about the cafeteria?  Restaurants have been known to get pretty messy bend the scenes.  Is the cafeteria the dirtiest place in the hospital?  How about the patient's room with all their friends and family?  Then there is the nurses station and the doctor's lounge and the laboratory break room.  Are they the dirtiest places in the hospital?

This question was presented to the readers of The Happy Hospitalist Blog Facebook page.  The collective responses contain the obvious collection of door knobs, shoes, keyboards and other commonly assumed dirty places in the hospital.  But some responses were unexpected.  Below is a list from readers like yourself of the dirtiest places in the hospital, with a handpicked Top 10 List for your reading enjoyment.  The next time you go to a hospital keep this list in mind and navigate carefully through these dirtiest places in a hospital.  Feel free to add to this list in the comments section below and help educate other readers on how to stay safe in the hospital.


TOP TEN DIRTIEST PLACES IN THE HOSPITAL


  1. The letter J on the computer keyboard right after it's used by a gastroenterologist.
  2. The 47 year old son that lived with his mother from room 110.
  3. The chicken nugget that has been photographed in the same place now going on two years.
  4. The leftovers in the back right corner of the nurse break room fridge that's been there for 6 weeks and counting.
  5. Homeless patient clothes.
  6. The curtains in Room 1.
  7. Used speculum collection after a night shift in the ER.
  8. The resident's white coat.
  9. That one doctor.  Everyday.
  10. The med student stethoscope, because they are the only ones that actually use it.

FACEBOOK RESPONSES

  • Elevator buttons.
  • Pulse oximeter.
  • The chicken nugget that has been photographed in the same place now going on two years.
  • The curtains that are around the beds. How many times do they get splattered on and are not changed?
  • The nasty phones us nurses carry so we can't get any patient care done! There is no way we remember to clean them after each room we go in!
  • Non disposable EKG leads in the ICU/ED.  They are always nasty and in need of a cavi-wipe soak!
  • Door knob to the dirty utility room.
  • The staff kitchen. No one cleans up after themselves. Frustrating!
  • Computer key pad or patient bed/tv controller.
  • Public phone in ER hall.
  • Tube system tubes.
  • I once cultured the bottom of my nursing shoes. There were things growing my microbiology teacher couldn't identify.
  • ID badges.
  • The mattresses! Bodily fluids just soak right in if your draw sheet wasn't placed correctly.
  • Bathroom door handles.
  • What is the staff refrigerator for $800 Alex.
  • Charts! No contest.
  • The hand rails.
  • The spouts on the soda machines.... One time my coworker cleaned them and they were full of mold! Gross!!!
  • The water cooler - folks just stick their bottles right up and over the faucet.
  • Floor! You know how many times a day or week it gets pooped or peed on?
  • Bottom of the OR tables.
  • The computer KEYBOARDS definitely!
  • The nurses lounge!
  • Ice machine!
  • The keyboard at any nurses station!
  • The nurses' lounge, hands down!
  • Waiting room bathroom in an inner city hospital.
  • Everything!  Especially the floor. I'm pretty sure the dirt just gets pushed around instead of cleaned!
  • Doctors ties or jackets (white coats).
  • The telephones.
  • Used speculum collection after a night shift in the ER.
  • The curtains in room 1.
  • Underneath the trauma beds. I've never seen the underside get cleaned. We have much blood loss Captain Kirk.
  • IV poles.
  • The letter J on the computer keyboard right after it's used by a gastroenterologist.
  • Patient nutrition room ice machines.
  • Any patient room. Even after being "cleaned".
  • The leftovers in the back right corner of the nurse break room fridge that's been there for 6 weeks and counting.
  • Keyboards, telephones and desk tops.
  • Handle on the exam lights.
  • That nasty carpet in the halls.
  • The resident's white coat.
  • Floors or the bottom of shoes!
  • Physician neckties and nurse badge lanyards.
  • Front entrance where one pushes or pulls the door.
  • Nursing lounge fridge vs the big bins of used dirty sheets waiting for wash.
  • Behind the computer screens.
  • Ice machine, hands down. Google it and gag when you hear what is found.
  • Door handles to the public bathrooms.  I always use a paper towel to open them.
  • My shoes.
  • Light switches in patient rooms!
  • The pump on the hand sanitizers, phones, keyboards/mice, and patient charts!
  • Desk doctors computers or mouse. ER patient gurney rails.
  • The telephones carried by any patient caregiver. Hands down.
  • The call button.
  • TV remotes.
  • Homeless patient clothes.
  • Door knobs, hand rails, soap dispensers, toilet handles, telephones, chairs, elevator buttons, my job has given me germophobia.
  • Call light/television controls in room.
  • Respiratory break room at my hospital!
  • The med student stethoscope, because they are the only ones that actually use it.
  • Family nutrition room.
  • The rectal tubes seems like an obvious winner.
  • The counter in the doctors lounge where they keep the donuts.
  • That one doctor.
  • Soiled/dirty equip room.
  • The 47 year old son that lived with his mother from room 110.
  • Trach patient's room.
  • Public water fountains are reportedly dirtier than public toilets.
  • The carpets in waiting rooms- they never get cleaned and people let their kids play and crawl all over them!
  • Little button on the water fountain.
  • Breakroom fridge door handle.
  • Doctors Lounge Floor
  • Guest coffee makers in the ED waiting area.


Dirty-Hospital-Coffee-Pot-Burner

"What if I told you the staff fridge is the dirtiest place in a hospital."

What if I told you the staff fridge is the dirtiest place in a hospital medical humor meme photo.

This post is for entertainment purposes only and likely contains humor only understood by those in a health care profession. Read at your own risk.


Peripheral Dopamine Order Now Requires SQ Option Per The Joint Commission.

Oakbrook Terrace, IL--  In an effort to enforce more accurate documentation,  The Joint Commission began mandating this month that all  peripheral IV dopamine orders contain a dual IV/SQ route of administration.  Previously, The Joint Commission only required hospital dopamine orders  to be administered through a stable and acceptable intravenous access site.
 Dopamine

Dopamine is a medicine frequently used by medical practitioners to support blood pressure or heart rate in the critically ill patient.  The Joint Commission says they have been made aware of thousands of incidents where physicians have ordered intravenous dopamine  through a dangling 25 gauge IV on the dorsum of the left 4th metatarsal with a blood pressure of  50/10 knowing very well that the IV is going to infiltrate into a fluid filled wheel of necrotic pus... and they order it anyway.

"All physicians know peripheral IV dopamine will eventually infiltrate into a subcutaneous route of administration.  We just want them to be honest with their documentation.  Providing an order for subcutaneous dopamine satisfies our requirement for accurate documentation and certification," said Mark Chassin, President and Chief Executive Officer of The Joint Commission.

While documentation accuracy may improve, some doctors worry giving subcutaneous dopamine may do more harm than good.  When given subcutaneously, dopamine can cause surrounding tissues to lose blood flow and rapidly die.

"I can understand The Joint Commission's desire for more accurate documentation but this policy just gives doctors an excuse for not putting in a central line and being a doctor," said Dan Stefbaum, lead author of The New York Time's Best Seller In Medicine, Shit Always Flows Downhill.

When confronted with concerns from patient advocacy groups, Mark said, "We know giving dopamine only through central invtravenous access is impractical and unrealistic and we would never expect any doctor working in an ER to place a central line against their best judgment.  As an organization that prides ourself on patient safety, finding middle ground in this policy was the only rational solution we could envision."

Some hospitalist groups have already responded with their own safety protocols to protect patients from this dangerous new policy.  "We have implemented an order for bedside 24 hour 1:1 monitoring with a care tech to watch the IV and notify the hospitalist stat when the IV infiltrates," said Devon Fenwick,  a hospitalist at the bottom of the hill.

Next week, The Joint Commission will discuss whether or not to allow surgeons to order antibiotics. 



Hospitalist Breaks Record For Ordering Most Consults in a Day

Los Angeles, CA -  Good Samaritan Hospitalist Ray Benford broke a world record Tuesday by ordering the  most hospital consults in a single day.  Guinness World Records was able to confirm Ray's 14 consults took out the old record of 12 consults in a single day that has stood untouched for 72 years.

"What do you mean?  I'm a Hospitalist," Ray said when asked to explain why a board certified internist would need so much help with one patient.

The  record breaking patient arrived as a transfer from an outside hospital with 457 pages of nursing notes, vital signs, a complete list of as needed bowel medications and no discharge summary, the normal train-wreck transfer protocol.

"I was pissed when the patient arrived right at my lunch time so I ordered a stat R.A.P.ER.S. evaluation to clear out the doctor's lounge."

The R.A.P.ER.S. acronym stands for Radiology, Anesthesiology, Pathology, Emergency and Surgery.  These  subspecialty physician species are notoriously known  for stripping bare the buffet line in the physician lounge minutes after opening, to the disgruntlement of all other specialties.

After eating lunch, Ray says he took a second helping to his office and entered consult orders for Gastroenterology, Infectious Disease, Nephrology, Cardiology, Pulmonology, Neurology and Dermatology to see for medical management. 

Rounding out the last two consults a  Rheumatology request and a second opinion Rheumatology request  was ordered at the same time to confirm the patient really didn't have Lupus.

"Technically, I only had 13 consults because the Dermatologist couldn't find the hospital, but they gave it to me anyway."