HHS and the death of "surge management"

one of the points made by the CA DPH head

in the Fred Friendly video seminar is that with a surge or pandemic, the rules all have to be rewritten - downward. We go from standard of care to sufficiency of care.

This rule would go first. of course, HHS and the medicare rule writers are different arms of the same octopus.

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by: DemFromCT @ Thu Jun 28, 2007 at 02:48:08 AM UTC

"Medicare's Important Message"

One arm of the octopus doesn't know what the other one is doing.

In the meantime [ie pre-pandemic] this will create unnecessary extended hospital stays, inevitably increase hospital-acquired infections, put some small hospitals out of business, and keep the people who need them out of acute care beds. It is redundant and complete overkill.

It is better to look ahead and prepare than to look back and regret.

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by: Grace RN @ Thu Jun 28, 2007 at 11:35:20 AM UTC

[ Parent ]

believe me, I'm not defending it!

I work with CRMs every day (clinical resource managers they're called here). Wonderful and creative people, numbed by the system sometimes. I get it. I'm just saying the issue is huge now, less so in a pandemic when the rule will be canceled early.

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by: DemFromCT @ Thu Jun 28, 2007 at 11:42:35 AM UTC

[ Parent ]

Long Term Care - already subject to discharge appeals

This kind of appeal process, which in some states can force the facility to provide care for an additional 4 months or more - potentially uncompensated - is already in place for medicaid covered patients in nursing homes (50-70% of the resident population). 

If the pandemic step-down discharge process (discharging everyone possible to the next lowest level of care) is to be effective and timely, all of these rules will need to be suspended on both a federal and state level. Unless this is done early and communicated well, the backlog will be huge. 

But just in time, we add the same dilema to Medicare covered patients in hospitals.  (Which often paves the way for private third-party payors to do the same.)

Fine thing for patients as long as we know how to undo it if we need to cut through it all quickly. 

(Would be interested to know if the hospital eats the interim costs if the patient appeal is denied - thus stretching budgets further and again reducing the financial ability to build any surge capacity or stockpile for JIC.)

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 

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by: Into The Woods @ Thu Jun 28, 2007 at 19:43:38 PM UTC

[ Parent ]

Why is it people think a new

piece of paperwork is going to solve the problem?!  When I worked in the mental health field the amount of paperwork that was generated was enormous.  Most of it wasn't even for the clients benefit but was to keep the clinicians and administrators from getting sued.

A possible solution, and granted I've been out of the system so long I may not know the current trends/problems ...

Have them have to appeal from a step-down facility rather than from the hospital itself.  They can be readmitted if they win their appeal, but going to a step down facility during the appeal process would certainly help hospital surge capacity and keep costs down for everyone.

But heck, what do I know.  Its just if someone is well enough to complain about having to go home, they'd certainly at least be well enough to go to a step down facility during the appeal process.

Never doubt that a small group of thoughtful, committed citizens can change the world, indeed it is the only thing that ever has. -- Margaret Mead

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by: KathyinFL @ Thu Jun 28, 2007 at 14:53:35 PM UTC