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Joined: 18 Feb 2003
Posts: 3
Posted: Thu May 01, 2003 4:59 am Post subject: aprnjam
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Find your story very interesting and so glad you are here to lend your expertise. I have a couple of questions. You've descibed how you couldn't keep your office open due to costs. But we read on ths board that dialysis corporations are swimming in $$$ as evidenced by their web boards and their ability to pay fines in the millions. I have it on good confidence that my doctors gross between 1 and 2 mil annually. They live in luxurious homes, drive luxury vehicles and vacation extensively. We are told that if the units are granted greater reimbursments they will not give better care and will just pocket the difference. We're told that they're making more than enough already with handsome profits from meds and by charging the private pay patients exhorbitant sums ( Medicare paying around $3000 per month per patient and private pay as much as $20,000 or more). So there seems to be a big discrepency in what you're describing you experienced in your practice vs what goes on in the dialysis arena.<
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>Also, this is off topic, but you mentioned you worked long hrs. Do you think stress leads to ESRD? I once asked my doctor this and he said absolutely not, but I wonder. My staff in dialysis works long hours without eating, drinking or using the rest room. Could that pattern damage their kidneys? <
>It is inpsiring to hear how you cared for your patients. Wish it was the same way in dialysis. What really gets me is when staff say how much they love taking care of patients, yet I see their care as terrible as they so often make my tx inferior by their lack of education and poor bedside manner. The world of dialysis is so backwards. Alot would have to change to ever normalize it.
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aprnjam
Joined: 28 Apr 2003
Posts: 85
Posted: Thu May 01, 2003 6:32 am Post subject: Re: aprnjam
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In my case, NP are paid at 78% of what a physician is paid, although we see the the same complexity of patients. Typically NP's see the patients that the physicians don't want to deal with. The ones that take an excessive amount of time, have multiple issues that you have to deal with, multiple psychosocial issues. We also see very few private pay patients, we normally only see Medicare/Medicaid patients. For a level II visit, the physician would be paid $28, and I would be paid $21.84. Where I take 30 minutes to see a patient, the physician normally takes 15 minutes. So, in an hour, I'm making $43.64 in compairson to their $152. That's how the NP ends up in the hole.<
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>Mine has told me the same thing, but from a pathophysiological standpoint, it just does not make sense. When you are not providing nourishment and fluid to your body as you should be, it puts your body in a stressful state, so therefore, it would seem to me that stress would contribute. I can tell you that on the days that I worked long hours, didn't take the time to eat, and only grabbed a cup of coffee or a coke, and only urinated once or twice, when I got home, I was exhausted, had 2-3+ pitting edema and was short of
eath. So to answer your question, I think that stress has some impact on a person with renal disease. Just my 2 cents worth here.<
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>In my opinion, a nurse who has a poor bedside manner does not love her job. If you love your job, then it shows in how you treat your patients. Because of the nursing shortage, too many people are entering nursing, not because they love nursing, but because of the bigger paycheck. I fire those people and let them look elsewhere. I won't tolerate anyone who doesn't care about their patients working for me. I also will not tolerate seeing a nurse treating a patient with disrespect. If I do not work at the facility, I look for her supervisor, if that doesn't work, then I go to Risk Management. If that doesn't work, then I make a complaint to the State Board of Nursing. If nothing else, the nurse will have the stress of answering a complaint by the State, which trust me is very stressful. For up to six months, you don't know what is going to happen. Whether it will be dismissed, whether you will lose your license, or whether you will be fined. There are ways to change their behavior, I've seen an state inspection do wonders for a nurses attitude.<
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>Thank you for the compliment. I do care about my patient's and I do love nursing. I hope to be back to soon!
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ridgerunner
Joined: 11 Jan 2003
Posts: 101
Posted: Thu May 01, 2003 11:23 am Post subject: nephrologist
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i am one of the old birds who was around when social security was started before medicare and medicaid welfare and a lot of social programs. it was a time before insurance. a working man could pay for his wife to have a baby. and pay his medical bills. i have seen some procedures increase by 10000 percent. so a simple procedure can
eak a working man. everyone cries just give us more money, a lot of people are trying to get on SSI every one is looking for a free lunch, there is no free lunch, the working is the one who pays. the increased life span is
ought about having clean water and the proper treatment of sewage, and antibiotics not any great advances in medicine.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Fri May 02, 2003 1:26 am Post subject: Can't help wondering
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if we got adequate dialysis , with dialysis schedules more suited to our needs, if we wouldn't return to tax paying status; of course so! It finally occurred to governement that people needed a handup not a handout (in regards to welfare reform) so why isn't dialysis being reformed too? If it were many of us could return to gainfull employment. Lin.
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Medicare
Joined: 02 May 2003
Posts: 1
Posted: Fri May 02, 2003 3:57 am Post subject: Medicare
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Medicare is different in the ESRD arena. Medicare dollars pay for the majority of the dialysis treatment.<
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>Dialysis Medicare has its own book. In this field of medicine what was to go to patient care is going into the pockets of the industry and physicians. The Medicare in ESRD sets the drs up in business.
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aprnjam
Joined: 28 Apr 2003
Posts: 85
Posted: Fri May 02, 2003 6:33 pm Post subject: Re: nephrologist
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Rigerunner, I have to agree with you. When my son was born 32 years ago, the bill was $1800, and that included the hospital bill! You can't have a baby for that anymore. Increased life spans are a result of people taking better care of themselves, eating better, learning more about their diseses processes and following the education (if they are lucky enough to get it) from their doctor or nurse practitioner. Antibotics have helped save a lot of lives. Infections that used to kill people, can not be treated with our advanced antibiotics. One of the biggest problems with antibiotics is the fact that people don't finish their prescription. They only take it until they feel better, then leave the rest sitting on the shelf, "until I need it again." What we have done by this process is create a world of resistant bacteria that think the traditional antibiotics, such as pencillin are candy. People go to their doctor when they have the flu, demanding antibiotics, when the flu is a viral infection and all the antibiotics in the world won't cure a viral infection. It has to run its course. But if you refuse to give a patient antibotics for a viral infection, they leave your office in huff, no matter how much you explain, and then some are kind enough to report you to the State Board for not treating their illness. Then you must respond to a state investigation that can take up to six months worth of excess stress on your life. You know that it will be dismissed, but you must answer it anyway or your license is in jeopardy. What angers me so much about SSI is that fact that I would see perfectly healthy looking people walk into my office, and I would look at their payor source and find out it was Medicaid. As I would sit there and read through
their chart, I could find no real reason for them to be on SSI. I don't know how many of these individuals that I asked why they were on SSI, and the responses I got astounded me. "I'm too nervous to work, I'm addicted to marijuana, I have nerve problems, I'm too depressed to work, I have back pain (one I saw moving a couch, and I just happened to have a camera, and I reported her), my favorite one was that my
easts are too big and my back hurts. The patients that truly needed SSI were denied. The patients were severe rheumatoid arthritis, who could barely walk, or the lupus patient with kidney damage. They were turned down initially and in the follow-up lawsuit. Where is the fairnest in that? How do the slackers get the funds and the people who need it don't? I don't understand the process at at. To the slackers, I say get a job. To the marijuana addicts, we didn't start your addiction, get in rehab and get off the stuff and get a job. If you're too "nervous to work" well get and job and maybe you won't be nervous. If you're too depressed to work, then get some help! Sorry soapbox issue here.
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aprnjam
Joined: 28 Apr 2003
Posts: 85
Posted: Fri May 02, 2003 6:43 pm Post subject: Re: Can't help wondering
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Lin, I totally agree with you. We don't chose to have ERSD, for whatever reason, we just have it. Our lives depend on a machine until we can get a transplant. Our lives revolve around when we can fit into someone elses schedule. They don't care that we are trying to maintain a job and stay off Medicare/Medicaid. We're numbers that people seem to want to go away. They make big bucks off our care, so as long as they keep us in this situation, then we don't get a hand-up. If they keep us in this situation long enough, then we will go away from all the complications that develop from ERSD and we're off their roles. Why do they want to give us chemicals that have been used and re-used. To cut their cost. Sure they say that they are the same, but I disagree. How can the chemicals that have run through 40 or 50 people be the same as fresh chemicals. Bull hockey. It can't, there is no way that you can convince me that it's the same. If you're number 1 or 2 then maybe, but what about number 48 or 50? Why can't the clinics fit OUR schedule so that we can work? Why won't our employers work with us so that we can work? I have a friend that her employer placed her on short-term disability, then long-term disability, which she will get for 2 years, at the same time, she gets SS. At the end of 2 years, her income is reduced from 4200/month to 1200. What happens if she can't find a donor by then? She's in the process of selling her home so she will have money if she needs it later on. Why should she have to lose everything. Sure the disability is nice, but what happens after two years? Wheres the hand-up to help? Sorry Lin, another soapbox..LOL. Joyce
