Physician Assistant Hires Physician Assistant Assistant to Help Manage Hospital Rounds.

Gainesville, FL -  Two years ago, Physician Assistant Stan Hanover P.A. was so overwhelmed with patients that he hired his own Physician Assistant Assistant (P.A.A.) team to better manage his rising patient load.  Rounding on 30 patients a day and admitting another dozen had become just too much for Stan to handle.

"I went to my Hospitalist group and said I need more money to hire my own team of Physician Assistant Assistants,"  said Stan.  "At first, they questioned the need for more help, until I told them the Dermatology clinic was hiring for days only, no holidays and no weekends  and they said I could have whatever I needed."

Physician Assistant Assistants:  We're here to help you do more!
Stan spent several months interviewing dozens of potential candidates before hiring three pre-P.A. college students for the job.    "I even interviewed a few nurse practitioners for the position but they all thought they were interviewing to be my boss, so that didn't work out," said Stan.

After completing a one week hospital sponsored H&P course - usually reserved for surgeons who need help with a pre-op  H&P - the physician assistant assistants were certified by Stan to begin caring for patients.

"I used to get upset when someone called me an extender, but now that I have extenders helping me see patients, I can see 60 patients a day and still have time to take a one hour lunch break with the docs."

The Hospitalist physicians couldn't be happier.  "We've tripled our census in less than two years but we're doing less and less work.  Now I just have to wave to my patients from the door and move on," said Dr. Alan Jensen, who now bills for over 100 patients a day and usually finishes two hours early.

Patients don't seem to mind either.  Having a physician assistant assistant, a physician assistant and a physician see them daily really makes them feel like they're getting their money's worth.  

"Nobody really knows who's who.  We all have physician in our name, which really helps a lot with our patient satisfaction scores," said Dr. Jensen while being interviewed during his third lunch break of the day.

To really push the physician angle, Dr. Jensen has encouraged all team members to introduce themselves with emphasis on the word physician while mumbling or lip-syncing their assistant or assistant assistant title.  

In addition, Dr. Jensen prefers only hiring males so as not to confuse patients.  "I'm not sexist.  I think women do an excellent job in medicine.  Unfortunately, when we hire women, patients think they are just a nurse and that really hurts our satisfaction scores,"  said Dr. Jensen.  

"I had to let all my female nurse practitioners go because we kept getting complaints from patients that only a nurse saw me today.  In fact we even fired our female Hospitalist physicians for the same reason," said Dr. Jensen.

Given the success of the P.A.A. program, Dr Jensen envisions having a fully functioning Physician Assistant Assistant Assistant and Physician Assistant Assistant Assistant Assistant program up and running in the next couple of years to continue improving operational efficiencies in an ever declining reimbursement environment. 

"In the next couple of years, I anticipate billing for at least 200 patients a day," said Dr. Jensen.

Frozen 2 Soon: The Anti-Vaxx Years Coming Soon!

Lake Buena Vista -- After the wildly successful Frozen franchise and ground zero to the largest U.S. measles outbreak since elimination was documented in 2000, the Walt Disney Corporation (WDC) announced the release of Frozen 2 Soon:  The Anti-Vaxx Years to capture the hearts, imaginations and wallets of an ever growing population of anti-vaccination families.

Frozen 2 Soon:  The Anti-Vaxx Years Coming Soon!
To compliment the movie, crews at Florida's Walt Disney World Theme Park have been feverishly working around-the-clock constructing the Frozen 2 Soon display at Magic Kingdom, where unvaccinated children and their vaccine averse parents can immerse themselves in a fully contagious experience with Influelsa, Tetanna, Meningolaf and other Frozen characters afflicted with highly contagious childhood diseases before vaccines became readily available  in the Kingdom of Arendelle.

Recent reports confirmed WDC had just started requiring proof of immunization before park entry, but a slew of subsequent lawsuits by anti-vaxx parents forced them to reconsider.

"We thought banning unvaccinated children - like guns and heroin -  from entering our park was a common sense policy that would allow millions of children to experience the magic of Disney without fear of contracting a potentially deadly illness because some parents in their own twisted minds believed not vaccinating their children somehow made them safer,"  said Walt Disney CEO Robert Iger.

"However, after careful consideration, WDC did not feel it was fair to the parents of unvaccinated children to exclude their little ones from the magic of Disney.  It's just not politically correct to exclude anyone anymore.  We hope the Frozen 2 Soon exhibit will recapture their hearts of the anti-vaxx community and we apologize for any pain and suffering our proof of immunization policy may have caused them,"  said Robert.

As proof of their sincerity, WDC promised 50% off park entry for unvaccinated children and free admittance for any child in the actively contagious stage of a vaccine preventable disease.

Anti-vaxx parents are thrilled with Disney's decision. A recent internet forum was abuzz with the incredible discounts being offered.   "All my kids wanted to go see the Frozen 2 Soon characters as soon as we heard.  My Allison says she can't wait to see Influelsa and Tetanna in their dresses while my  Jamie hopes to get a picture with Meningolaf and Polioaken together," said a defiant anti-vaxx parent going by the moniker Duke of Measleton.

"I'm hoping at least one of them gets measles or whooping cough before our trip next month to save us some extra money."

Despite the  excitement, the internet parent did express sadness for Robin, her third daughter being left at home for the family trip.  "I'm so angry at my pediatrician for accidently vaccinating her last year when I stepped out of the room to use the bathroom.  She would have loved too meet Hansophilus and scary Mumpsmellow snow monster, her two favorite characters.

Disney promised to provide a fully contagious experience for the diehard anti-vaxx community by working with the Centers for Disease Control and Prevention to obtain live virus samples of childhood diseases for injection by roaming Disney Characters  while listening to  Do You Want To Get Pneumonia?,  For the First Time VaccinatorHe's a Bit of an Anti-Vaxxer, and Let It Grow in the background.

"I'm just praying we get lucky enough to find the Meningolaf so my kids can experience the thrill of polio first hand.

Families Thrilled to Know Comfort Care Chemotherapy is an Option.

Boston, MA -  After years of poor patient satisfaction scores threatened to get Dr. Betty Jensen kicked off the medical staff at Monroe Hospital, she became the first Palliative Care physician in the country to start offering end-of-life comfort care chemotherapy last year and the results have been nothing short of remarkable.

Comfort Care Chemotherapy provides peace of mind.
"I could actually feel the tingling deep inside of my patient satisfaction scores rising in real time as patients called out for one last dose of deathbed comfort care chemo before passing peacefully on the vent surrounded by friends and family in the ICU," said Dr. Jensen, who went from worst to first after implementing her chemotherapy protocols.

But life wasn't always so good for Dr. Jensen.  "For years, I was living in fear of my next patient complaint.  Then it hit me one day.  I am a palliative care service.  Cancer patients seem to love palliative chemo.  It just made sense for me to start offering end-of-life palliative chemo to optimize the patient experience," said Dr. Jensen, who now works closely with several oncology groups to maximize her patient satisfaction scores.

At Monroe Hospital, every palliative care consult now gets an automatic oncology referral to make sure no end-of-life patient dies without chemotherapy.  For the last six months palliative care and oncology have been working side-by-side in a symbiotic relationship, maximizing end-of-life comfort care patient satisfaction scores.  Patients and their families have had nothing but praise for this aggressive approach to death with dignity.

"My mother was 92 years old and hadn't been in an upright position in three years.  We knew it was finally time for comfort care when the surgeon said enough was enough after  172 decubitus ulcer debridements failed to make her better.   We thought they would just pump her full of sleeping drugs and let her die a miserable death without food and water, but we were thrilled when the hospice doctor recommended comfort care chemo.  That's why we love this hospital so much. I just wish end-of-life comfort care chemotherapy was available when my father died.  We could have prevented so much suffering," said the daughter of one satisfied patient, who prides herself on being an excellent advocate for patient rights.

Dr. Jensen agreed.  "We used to tell families and patients about dying with dignity but that just got them all riled up.  Now we tell them about dying with chemo and their ears perk up.  They become excited to hear more.  They are thrilled to know end-of-life doesn't mean end of treatment.  And word must getting out about our great service because we've already been asked by several nursing homes this year to start providing end-of-life skilled nursing home chemo."

Finding the right mix of chemotherapy was not always easy.  Dr. Jensen spent many months trying to find the perfect combination of drugs for her protocols.  "Comfort care chemo is more of an art than an exact science.   In the early days, we caused a lot of unnecessary pain and suffering by being too cautious with our dose adjustments for age and renal function. But we got over that fear after time and time again our patients and their families told us not to hold anything back because their mother was a fighter."

Hospitalist vs ICU End of Life Palliative Care Video

Hospitalist vs Oncologist Video

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.