The article I read this week was about four people that were indicted for a telemedicine fraud scheme of $931 million in Tennessee. The team of four were able to submit at least this much money in fraudulent claims through tricking thousands of patients and over 100 different doctors. Peter Bolos, Michael Palso, Andrew Assad, and Larry Everett Smith were the four men working for the telemedicine company HealthRight that were indicted and charged with conspiracy to commit healthcare fraud, mail fraud, and “introducing misbranded drugs into interstate commerce.” This was all according to the U.S. Justice department. The way they went about this fraud, was they would get approvals for invalid prescriptions for doctors then bill companies such as Blue Cross and Blue Shield of Tennessee for their greatly marked prescriptions and taking in the extra payment. This went on for over three years until it ended in April of 2018. This affected not only these four men, but also Scott Roix, the CEO of HealthRight pleaded guilty to felony conspiracy. As this article was quite tragic and shows how scheming is a real thing and can affect not only those involved, but those that are deceived by the lie. This is good to know because it shows that we should always check our sources and make sure we are not being scammed by companies. I will be able to apply this by knowing what companies I am dealing with and researching where I am getting my information from. I will also advise my patients against getting things from companies that they are not familiar with or have not done their research on.
The article that I read this week shed light on February 17, 2009 when “President Barack Obama signed legislation that created the federal government’s meaningful use electronic records incentive program.” After almost 10 years and $35 billion in federal incentives, hospitals and health systems are still struggling with EHRs due to new installations as they disrupt the workflow and cost hospitals millions. The article titled, “No end in sight: EHRs hit hospitals’ bottom lines with uncertain benefits.” This really tells how the rest of the article explains that there really is not end in sight and the government keeps trying to adjust things through legislation, and it simply seems to keep costing them money and not further progress to where it should be. In 2016 the federal government poured an astounding $34.7 billion into incentives for adopting EHRs which ended up split among health systems to install new health record-keeping software. For example, the Mayo Clinic made up a chunk of the $1.5 billion investment in new technology. Partners HealthCare additionally spent $1.2 billion on an Epic EHR. These EHRs are meant to help hospitals and health systems more efficient, both clinically and financially.
Though this article is quite pessimistic, it does show that there does not seem to be an end to the promises made by the federal government, as the benefits are never quite certain. So much money can be poured into one area, but the rewards are not so plentiful. I can apply this to my current nursing practice by better understanding the benefits promised from the incentives provided by the federal government.
The article I read this week, titled MBA Programs for Physicians: 2018, discussed a list of the nation’s largest business graduate schools for physician-executives. These schools are based off of the number of full-time students from this last year of 2017-2018. The article explains that each graduate program school includes the rank/institution name, degree programs, number of full-time and part-time students, tuition from the last 2017-18 year, number of total graduates of the program to date, length of the program in months, age of the program in years, and comprehensive answers to open-ended questions. All of the information provided in the list is information that is self reported from those institutions that have participated in the Modern Healthcare’s 2018 Business Graduate Schools for Physician-Executives Survey. However, those that did not participate in the study are not listed in the rankings. This is a great article because it lists some of the highest ranking schools in the nation. It gives direction as to where people will want to go based off of the different criteria and helps to really open up ideas to physician-executives.
I will be able to apply this to my current nursing knowledge by teaching people about the ongoing education that happens throughout all of healthcare. Physician-executives are now being urged on to gain more knowledge and pursue their education. This is something that inspires me and will motivate me to further my own education.
I was able to read an article this week addressed the issue of the increasing rate of physician suicides. The higher incidence of suicides among physicians is nothing new; however, the healthcare industry is doing much more about it now than ever. The article outlines a story of a surgeon, Dr. Michael Weinstein from Philadelphia who suffered from deep depression and ended up receiving treatment from a primary healthcare provider. He underwent electroconvulsive therapy and took a leave from work in order to receive treatment and focus on himself. He felt that he could not discuss his issues at work or seek help, in fear of looking weak. This fear is believed to contribute to the reason as to why experts believe that doctors have a higher rate of suicide than the general population. They also explain that in medical school, the idea that physicians should be strong and put the health of their patients before themselves is drilled into their heads, adding to the pressure. Again, though this is not a new concept, the industry is responding more now than ever. They are implementing more awareness in residency and medical school to help future physicians to be ready for such mental trials and to encourage them to seek help and let down the need to look perfect among their peers or even their patients. They too can be patients, and should very well be if struggling with depression or any sort of mental health condition. This is great to know because I will be working with physicians and am also in the healthcare industry. Doctors aren’t perfect and never have been. However, I should do my best to create a positive work environment for the physicians I work with and never set the bar too high or increase the pressure of physicians.
The article I read this week addressed the issue of the increasing rate of physician suicides. The higher incidence of suicides among physicians is nothing new; however, the healthcare industry is doing much more about it now than ever. The article outlines a story of a surgeon, Dr. Michael Weinstein from Philadelphia who suffered from deep depression and ended up receiving treatment from a primary healthcare provider. He underwent electroconvulsive therapy and took a leave from work in order to receive treatment and focus on himself. He felt that he could not discuss his issues at work or seek help, in fear of looking weak. This fear is believed to contribute to the reason as to why experts believe that doctors have a higher rate of suicide than the general population. They also explain that in medical school, the idea that physicians should be strong and put the health of their patients before themselves is drilled into their heads, adding to the pressure. Again, though this is not a new concept, the industry is responding more now than ever. They are implementing more awareness in residency and medical school to help future physicians to be ready for such mental trials and to encourage them to seek help and let down the need to look perfect among their peers or even their patients. They too can be patients, and should very well be if struggling with depression or any sort of mental health condition. This is great to know because I will be working with physicians and am also in the healthcare industry. Doctors aren’t perfect and never have been. However, I should do my best to create a positive work environment for the physicians I work with and never set the bar too high or increase the pressure of physicians.
- How many people do you usually work with in order to manage a budget?
- at least another person who helps with the financial advisory.
- What is the hardest thing about managing a budget?
- sticking to the budget planned. Certain expenses come up and are necessary, even though they exceed the amount set for the month.
- How often do you look over the budget?
- at the beginning of the month and end for sure, as well as at least once a week to make sure things are going according to plan.
- How often do you make changes to the budget?
- I try to stick to the budget, but it is not abnormal to adjust the budget once or twice a month.
- How far in advance do you prepare a budget?
- at least 2 weeks before the month starts
- Is the budget a yearly plan, quarterly plan, or monthly plan?
- monthly plan
- If you are over budget, what is the first thing you do?
- look at the areas that I clearly spend too much on and make cut backs for the next month.
- How vital is it that you stick to the exact budget? Is there any leeway?
- I try to make room for leeway in case of emergency – that way I can be left with a little more at the end of each monthly budget and if I go over, it is not as big of a deal.
- Are you held responsible if the budget is over?
- Yes, I am in charge of ensuring that the company does not overspend the budget I have set. All company expenses are ran through me.
- What is an example of a factor that goes into budgeting that is less known?
- Where have you noticed that you’re consistently gone over the budget?
- We often create donor projects that we make sure things look perfect for these donors, yet we end up spending too much on that rather than keeping to the budget and putting the money in more essential areas.
- What area is the hardest, yet most necessary to make budget cuts?
- Probably the hardest thing to make cuts on are the little things that keep adding up such as garden supplies and the little ares with donor projects.
Red Butte Garden, Desi Guerrero Financial Analyst Assistant / Garden manager.
I learned that there are a lot of things to think about when it comes to budgeting. There are a lot of things that cross over from non-healthcare related companies to healthcare related companies. There are always areas that are considered unnecessary spending and these areas are often some of the hardest to cut down on.
The article I read this week discussed the recent event of the U.S. House of Representatives passing a large amount of bills aimed at diminishing the opioid crisis in America. It explains how lawmakers are using a loss ratio to pay for the legislation from Medicaid. Over a decade of putting these bills into action, the Congressional Budget Office estimated to save the government about $2.6 billion. Additionally, the CBO estimated another $2 million saved from the opioids package. In the past, addiction treatment advocates and industry lobbyists have felt that the funding in legislation is not sufficient to fight the opioid epidemic. In 2017, over 47,000 Americans died due to this epidemic. In this package that has been signed to reduce these numbers, it requires a mandatory training for nurse practitioners and physician assistants to prescribe medication-assisted treatment. In doing so, NPs and PAs will have a better understanding and be able to join in the fight against the opioid epidemic. This is great information, especially since I am wanting to become and nurse practitioner and will likely be prescribing medications as well. As a nurse, there have been times when the physician has ordered opioids for the patients while in the hospital, but does not prescribe them such heavy pain killers to go home with. Some patients are annoyed at this, but after a thorough explanation, they are compliant and agree with the physicians judgement. This is a sticky and controversial area, as patients feel the need to stay on top of pain. However, joining in the fight against this epidemic can have a great lasting effect on the nation.
The article I read this week discussed how the Centers for Medicare and Medicaid Services (CMS) has made plans to stop big time hospitals from rejecting ambulatory surgery center (ASC) patient transfers. Currently, there is a requirement that surgical centers must have an actual written transfer agreement with potential hospitals or they must ensure all doctors performing surgery have admitting privileges in nearby hospitals The CMS is suggesting that they remove this requirement to make it easier to transfer between surgical centers and hospitals. There are many stipulations that the hospitals must follow and some of the policies have even led to transplant programs avoiding performing transplants, but only for certain patients which uses some organs to go unused and wasted. In addition, the CMS is pushing for streamline access for X-ray services. The article explained that over the last year, “the agency has taken action to address 55% of the 624 topics considered burdensome by the industry. Another 16% of the topics remain under consideration and 29% were either referred to another agency or did not require further action.” This is a large amount of issues and topics that are considered burdensome, and also the large amount that are still under consideration. This is useful knowledge as a nurse to understand that policies are constantly changing. I will be able to apply this information into my practice by educating patients that they should be up to date with the different policies, and that I should constantly be kept up to date as well, as they are constantly changing.
Additionally, we discussed budgeting for hospitals and the floor. It is something that we might not deal with directly as nurses, but is something that we should be aware of as many of us aspire to move to a position where we will deal with such things. It is also important to us as nurses so that we do not contribute to the wastefulness in hospitals in regards to supplies. I will apply this to my nursing career by not being wasteful and being more aware of the hospital budget for my floor.
Way Point Wanders, Kristin Douglas, CEO
- How many warnings do you typically give an employee before termination?
- I generally give 2 or 3 depending on the severity of the action.
- In what cases would termination be immediate?
- Theft, criminal offense, unnecessary dispute.
- Do you have other employees or leadership sit in for firing/discipline meetings? If so how many?
- No, I run a small company and having multiple people in there would only be more dramatic rather than professional.
- Do you let other employees know when someone has been terminated?
- Yes, I like to keep everyone on the same page and let them know that they will have another member to their team hired on.
- Do you need approval from other managers/higher-ups before termination?
- No, I am the CEO of my small company and I do not have other managers at this time.
- Do you have benchmark criteria that you follow when disciplining an employee? Who created the criteria?
- Since my company is smaller, I do not have a certain criteria. Every situation is different and luckily for me, I have not had too many issues with my employees so far.
- Have you ever terminated an employee and then re-hired them at a later time? Why?
- Where do you discipline an employee? (which room, private or partially public)
- In my home office.
- Have you ever given a second chance based on circumstance even though protocol stated otherwise? What situation would allow this?
- Yes I have given second chances, though there is no real protocol to be met.
- What is the hardest thing about terminating an employee?
- Losing a team member and the emotional reaction that they have. I never like hurting people’s feelings.
- What have you found is the most effective way of giving warnings to improve behavior?
- Talking face to face and explaining the disappoint in their actions and setting a plan to improve.
- What are examples of things that may be found inappropriate by other employees but are not worthy of termination?
- Personality differences, arguments among employees, etc.
I learned that the firing process is much different in smaller companies versus larger companies. The CEO and the employees are much more close and they often have connections to each other. When people are hired on a know-basis, this also makes discipline and termination much more difficult.
The article I read this week talked about how Ken Burns highlighted the PBS documentary from Mayo Clinic. The documentary, “Faith-Hope-Science” discusses how current systems practice today are influenced by history of healthcare and health based systems. It also dips in to how the history of the Mayo Clinic, explaining how they used only employed physicians, paid on a salary, rather than fee-for-service independent physicians and how they were able to make subsidized payments for poor patients – even back in the 1900s. The article explained one of Mayo’s historical messages that, “you can be entrepreneurial and competitive and idealistic and put the patient first all at the same time… That is the message now that leaders of these organizations all across the country are trying to tackle.” This is a great article, because it holds true to the values that healthcare puts in its foundation and helps healthcare workers to see the importance of putting the patient first, all the while being entrepreneurial, competitive, and idealistic. I will put this into my own practice as a nurse by always remembering to put the patient first and remember why I became a nurse in the first place.
In addition, we discussed many of the ethical dilemmas of leadership and what we should do when we are faced with such issues. It was brought up that ethic committees are used only three times a year. This is interesting, as there are far more issues that arise than only three times a year. However, these committees are very helpful when it comes to these ethical issues that can effect the whole community. I will be able to apply what I learned this week by being an advocate for the patient at all times and to have my own base of beliefs in order to give full care to clients.