When the time finally came, I came to the ICU thinking I knew all that there was to know about Critical Care Medicine. I came to the ICU fully confident in my abilities to crush critical illness and save every patient I saw. I came to the ICU roaring like a lion…until I met the ICU nurses.

They whipped me into shape real, real quick. They showed me, in short order, what I didn’t know, and they showed me how to be properly behave in the ICU. I came to the ICU roaring like a lion…and the ICU nurses left me meowing like a kitten. And that experience taught me very early on to NEVER cross an ICU nurse.

The nurses in the ICU are among the best nurses around. They are highly skilled, highly educated, highly motivated to do what is right for the patient, and they do not back down easily. They will keep fighting for the patient with all their might, all their passion, and all their soul. I am not saying that other nurses do not do this. I am saying that ICU nurses do this par excellence.

I was witness to their selfless care during the COVID-19 pandemic. They spent hours at the bedside of countless very, very sick people with COVID-19. They gave them everything they had, and if the patient was not going to make it, they made absolutely sure the patient did not die alone, holding their hand in the room while the family was mourning on an iPad or cell phone.

They are such an important component of the care of the patient in the ICU. I was – and continue to be – in awe of their excellent patient care, and I am grateful to be their partner in the ICU.

As I said before, when I first came to the ICU, they whipped me into shape real, real quick. I learned to NEVER cross an ICU nurse, and their tough love made me a much better critical care doctor. I am forever better because of those ICU nurses with whom I worked my very first month in the ICU as a doctor. And to them – along with every other ICU nurse – I am forever grateful.

The post ICU Rule #9: NEVER Cross An ICU Nurse appeared first on Medika Life.

In previous articles, we have been discussing the various different types of reasons insurance companies deny payment for services rendered by hospitals to their patients. Perhaps the most annoying and frustrating for me is the “30 day readmission” denial. This is a denial in which payment is denied for a hospital stay that is within 30 days of a previous hospital stay. The allegation is that the patient was inappropriately discharged from the previous hospital stay, and thus the subsequent stay should be considered part and parcel of the first, what we call the “index,” hospitalization. I have seen these denials come through even with hospital stays three weeks later, even for a different reason. 

Now, the Centers for Medicare and Medicaid Services, affectionately known as CMS, also penalizes hospitals for excess readmissions within 30 days. It is called the Hospital Readmission Reduction Program, and it tracks the ratio of the predicted-to-expected readmissions to the hospital for the following conditions: (1) acute myocardial infarction, (2) chronic obstructive pulmonary disease, (3) acute heart failure, (4) pneumonia, (5) coronary artery bypass graft, and (6) elective total hip and knee surgery. If there are excessive readmissions to the hospital for patients with any of these conditions, payments to that hospital are reduced the following year. 

Some commercial insurance companies have taken the concept of this program to the extreme by denying payments for any hospitalization, for any reason, for any condition within 30 days. For example, if a patient is admitted to the hospital for pneumonia, and then suffers a heart attack three weeks later and admitted again for the heart attack, I have seen commercial insurance companies deny payment for that subsequent hospital stay, even though it had nothing to do with the previous one.

CMS claims this program “encourages hospitals to improve communication and care coordination to better engage patients and caregivers in discharge plans and, in turn, reduce avoidable readmissions.” This goal, of course, is laudable. Everyone wants the best quality care if they must be admitted to the hospital.

At the same time, a readmission to the hospital is completely unavoidable. Sometimes, as I mentioned previously, a patient suffers an unexpected complication such as a cardiac arrest. Sometimes, a patient is in a car accident and has to be admitted to the hospital. Sometimes, a patient does not follow medical instructions, such as taking diuretics to reduce total body volume for heart failure, and they present back to the hospital for another exacerbation of heart failure. Sometimes, it is unfair to penalize a hospital for something that is beyond its control.

At least, CMS tracks a ratio rather than an absolute number. The denials I am talking about here are absolute: a payer will simply deny payment because a patient is admitted to the hospital within 30 days. Even if it is 29 days, I have seen these denials come through. And, frequently, there’s absolutely no explanation as to why the denial occurred. 

Moreover, many times, the subsequent hospitalization is very long because the patient is extremely sick, such as suffering cardiac arrest and having brain injury due to lack of oxygen. To simply deny the subsequent hospital stay because it happened to occur within 30 days of a previous hospital stay is inappropriate and beyond frustrating. “Ensuring quality of care” by by making such a denial is disingenuous at best. 

It is one thing if a hospital, seeking to minimize length of stay, prematurely discharges a patient while they are still clinically unstable: for example, with an incompletely treated infection or still with significant heart failure. That hospital deserves to be penalized for a readmission. I can say, with a reasonable amount of certainty, that most hospitals do not fall into this category. 

Most hospitals try their best to treat the patients entrusted to their care in the most appropriate and efficient manner as possible. I can understand CMS’ readmission reduction program. The readmission denials I see coming from commercial payers are simply punitive and wholly unnecessary. 

It is unlikely that these types of denials will ever go away completely, especially given the presence of the CMS hospital readmissions reduction program. I can always see commercial payers pointing to the program as inspiration for their own 30 day readmission denials. At the same time, I am going to call out their callous and arbitrary nature. With all the challenges and challenging environments we in healthcare have to deal, needing to expend precious resources to defend denials such as these is truly baffling. 

The post From The Appeals Desk: The “30 Day Readmission” Denial appeared first on Medika Life.

Almost every day, I am witness to one of my critically ill patients “losing the battle” with their critical illness. This was especially true in the Spring and Summer of 2020, where we witnessed patient after patient “losing the battle” with COVID-19. It is part and parcel of my job, and when I recognize that my patient will more than likely “lose the battle” with their illness, it then becomes my job to try and minimize their suffering as much as possible, along with helping the family minimize their grief as much as possible.

While it may be uncomfortable to reflect upon, it is nevertheless inevitable that all of us – every single one of us – will, one day, “lose the battle” with some sort of illness, condition, or accident. One day, someone will say that we will have “lost the battle” with this or that. That should not be our main concern. The main question be this: will we have won the war?

The human condition is full of battles: battles against its hypocrisies, battles against its vicissitudes, battles against its difficulties, battles against its contradictions. There are also battles against personal moral struggles and physical illnesses. All of those battles constitute the overall war, and it is one that is waged each and every day by each and every person.

If we can conquer the hypocrisies, vicissitudes, difficulties, and contradictions of the human condition; if we can conquer our personal moral struggles, then we will have won the war, even if we lose a battle against a physical illness, condition, or accident. And, to me at least, winning the war is much more important in the overall scheme of things. The reward of winning the war, to me at least, is eternal, and that is my ultimate goal in life.

Now, some of the battles against illness can be quite brutal. I do not dismiss them in the least. My daughter suffered tremendously in the six months she received chemotherapy before she died. Almost every day, I witness the brutality of critical illness and what it can do to the human body and human psyche. Sometimes, many times, “winning the battle” against critical illness can actually be worse than death itself. This was especially true with COVID-19. I pray none of us suffers the casualties of a particularly difficult battle with illness.

At the same time, if we lose the war of the human condition, the consequences can be devastating and eternal in nature. That must be avoided – in my belief, at least – at all costs.

As the years have passed since my daughter’s death, my goal has been singular: put my head down and live a life of righteousness to the best of my ability. That way, when I lift my head up, I will see the Face of the Lord and once again see the smiling face of my daughter. I am trying, to the best of my ability, to win the war of the human condition, with the help of the Precious Beloved.

I pray that I am ultimately successful. I pray that, one day, people will say about me that I “lost the battle” but ultimately won the war.

The post Every Single One Of Us Will “Lose The Battle” One Day appeared first on Medika Life.

Pandemics, ice storms, and power outages do not stop pregnancies or those who care for them. Pregnant people need care, and their babies are still coming out. Caring for our patients is goal number one, but we can not do it if Covid-19 or a winter storm keeps the office doors closed. 

The Texas storm’s first strike hit the Dallas/Fort Worth region on Thursday, February 11. Our practice made the fast-acting decision to close for inclement weather. We always strive to stay open and operational to the best of our abilities. Still, we closed because the icy roads presented a hazard for our staff and patients.

After Thursday, the practice had to come together and make some tough decisions. The weather reports were getting worse. From everything we read, the following week was going to be an environmental catastrophe. We knew it would be freezing cold with lots of snow, but we had no idea the Texas electric grid would collapse, leaving millions without power or water.

The operations team took preemptive action behind the scenes in a whirlwind of meetings, phone calls, and text messages. We needed a plan to provide safe, effective patient care without putting our staff or patients in danger. The Operations and Clinical teams worked together to ensure the plan was agile and fool-proof.

The first priority was planning for Monday’s snowstorm. We followed our step-by-step operations and communications weather-related playbook. The expected snow, ice, and brutal temperature drops arrived on schedule. What followed was state-wide power outages.

Our plan was to convert most of our visits to Telemedicine. As the morning arrived, many of our providers had no power or Wifi access. Our communications center suffered the same challenges. Using SMS technology, we were able to communicate the rapidly changing plans to our patients. Despite the challenges, we were able to make 7246 rescheduling phone calls and messages. 

Two of our physicians moved into a hotel after losing power. At 3:00 am, the hotel lost power and electricity as well. Most of our providers lost water and quickly learned how to flush toilets with snow.

Chief Operations Office Johan Hultman stated, “We had a plan, and we worked the plan. As things progressively got worse, we reworked the plan. We dealt ourselves as many cards to play as we could, and that gave us the ability to maintain control.”

By Wednesday, the weather had somewhat improved. We opened the office late and extended hours to allow patients and staff to drive during daylight. Staff members without power and water came early to shower and brush their teeth. The doctors who could safely make it to our offices saw 752 patients. 

The entire team worked together to care for each other. Two physicians with pick-up trucks ran a shuttle service to chauffeur office staff. Other team members took bottles of water to their coworkers. 

We did not have enough available medical assistants to staff an entire team. Our providers had to improvise. I moved into the nursing workstation to check vital signs, perform the urinalysis, and enter all data into the electronic record system. 

Health technology helped us manage the crisis. 

While sometimes challenging, the rise of technology in healthcare helped our practice manage through the challenges. Expanded Telemedicine services allowed us to continue to see patients when they could not safely come into the office. 

Some providers called patients from their homes or hotel rooms as they struggled with the same power and water issues as the rest of the community. Despite the challenges, we completed 352 virtual visits.

Crisis communication is critical. 

During a crisis, the mission is simple: organize, prioritize, plan, and execute. Unexpected challenged can bring down companies and paralyze leaders. Situational threats may leave teammates feeling overwhelmed.

The Operations Team and Clinical Team met virtually at 6 am and ended their days closer to midnight as they finalized provider, staff, and patient communications and contingency care plans. We needed to know which staff members had power, water, and safe transportation. 

Multiple communications went out throughout each day to keep all team members up to date with the rapidly changing situation. Everyone knew what to do and where they could best help. 

Here comes the sun

By Saturday, the temperatures rose, and the sun came shining through. Most of our staff had power. Many still lacked water. We had accomplished the most important goal — we provided safe and effective care for our patients under challenging circumstances.  

As we approach the one-year mark of the pandemic onset, I reflect on the past year. There is no other way to say it; it has been a difficult year to be a healthcare provider. 

Despite Covid-19 and Texas Winter Storms, it feels really good knowing that careful, diligent planning and the ability to change directions and innovate is what has kept our team operational.

We are getting through it together. 

The post Practicing Medicine During a Historic Winter Storm in Texas appeared first on Medika Life.

Date of Release:  Sept. 18, 2020

NEW YORK, /PRNewswire/ — Castle Connolly Private Health Partners (CCPHP) and Medical Economics teamed up to offer a possible lifeline to private practice physicians around the country. The two organizations hosted a webinar for over 300 physicians across the nation on Wednesday, August 26^th which featured two top concierge physicians sharing their experiences navigating private practice in this day and age.

Dr. Kim Parks of Synergy Private Health, in Massachusetts and Dr. Paul Knoepflmacher of New York City, both CCPHP Partners, shared their stories in a candid discussion with Dr. Dean McElwain, President, COO and Co-Founder of Castle Connolly Private Health Partners. They discussed the challenges facing private practices even before the “COVID Era,” their thought processes in deciding to convert their practices to a concierge model, the conversion process as well as navigating the pandemic as a concierge physician.

The discussion was a true glimpse into the process of transitioning a practice and how it can be a great solution to the issues facing private practices. Many are struggling, MGMA reports that 97% of private practices have been affected financially by the pandemic. Even before March of 2020, many practices were dealing with decreasing reimbursements, increased administrative duties, physician burnout, and a revolving door of patients with increasingly complex needs that can’t be addressed in a 7-minute visit.

So many doctors are considering selling their practice to a large hospital system, however, that can come with another set of challenges such as being held to a certain number of RPU’s and less autonomy when it comes to running the practice on the day to day. Other physicians are contemplating early retirement leaving their patients to scramble and find another physician amidst a pandemic. Dr. Parks and Dr. Knoepflmacher explained exactly how transitioning to a membership model saved their private practices. To watch the full webinar and learn more, follow this link: Webinar

CONTACT: Lisa Wielgomas, 212-367-1950 ext. 1003, lwielgomas@ccphp.net

SOURCE Castle Connolly Private Health Partners, LLC

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