Tuesday, April 27, 2010

Remember the HMO?

I remember about 5 yrs after I graduated college and was working "the floors" at the hospital and a new concept in insurance pay came into being. The HMO or "managed health care". The insurance companies decided to "manage the cost" of treatment by offering the hospitals and doctors it's clients for a set fee (managed health care). This meant that a hospitalization for an illness, say, a case of heart surgery would be allowed a set number of days in the hospital and a set fee for those days and to the doctors, a set fee for their services. Blue Cross and Blue Shield is a big company and it's clients are many. In order for the hospitals and the doctors to get these patients, they would have to agree to be paid this "discounted fee".
To the doctors and to the hospitals, this meant a drastic drop in pay. To offset this, the hospitals try to cross train the nurse aides to do food service workers jobs and the food service workers had to cross train to be nurses aides. This was a disaster. The food service workers were not interested in patient care. That's why they were food service workers instead of nurses or nurses aides. The nurses were give a higher patient load with no consideration to patient acuity. Patient acuity is a rating given to a patient based on the amount of care and the seriousness of their condition. Respiratory therapy would be offered by the nurses. Phlebotomy would be another responsibility of the nurses. The nurses were overburdened and over stressed. Many times the aides were removed from the floor leaving the nurse to do total patient care with a greater number of patients. The hospitals were not going to take a loss on their expected income. Charges for supplies used on a patient were increased X300. I'm saying the cost of scalpels in surgery, cotton balls on the floor, syringes and any and everything that could be charged the insurance company was charged at a rate of 300 percent over what the actual cost of the item. The doctors opened their own rehabilitation clinics and surgery centers. As in the foot splint that was provided by my podiatrist/surgeon, the actual cost was 56.00 and his charge to me was 300.00. The doctors weren't going to take a loss in revenue dictated by the insurance companies "managed health care". It's a win/ win situation for the doctors and hospital and the insurance company who charges a higher premium rate to compensate. The loser? The insured and those who have no insurance at all. The health care worker loses too. Over stressed and overworked, nurses are always in short supply. There are plenty of trained nurses. They aren't working in the field but have found other employment. The new nurses coming out of school are soon overwhelmed and looking to leave. Many go back to school to get a teaching certificate and head for the classroom to teach.
Though I did like the patient interaction at the start of my career in the field, soon the job didn't allow any time for individualized care. It was a matter of getting into the room, attending to dressing changes, iv site care, pain pump management, med administration, hang antibiotics on time, restarting iv sites, responding to requests for relief of discomfort, reporting to the doctors any change in patient condition, getting new orders, requesting pharmacy meds and administering and prepping the patient for surgery. This was on a patient load of seven. Seven patients that were sick enough to be hospitalized. Little time was left for patient education on their course of care; checking to make sure they understood what was expected of them in management of their medications on discharge and on and on and on. Did I mention the paperwork? That was usually done after the shift had ended. You stayed clocked in and spent the next hour or so doing all the charting and checking to make sure all orders were attended to. Usually before you ended your shift, there was a supervisor on the floor requesting you to "stay over", do a double shift because someone had called in "sick".
What you may ask has inspired this post? I was watching an interview with a patient by the news media on "The Cost of Healthcare". The bill from the hospital was scrutinized and the charges were outrageous. The hospitals response? It was weak. They said "we have to charge these rates on supplies to make up for the shortage of pay in other areas" and those "other areas"? Yep, the insurance companies "manage health care" payments!
If you think your doctor really cares about you, then I have a bridge in London Arizona for sale.........


  1. HMO worked well for me, but not for my boss and it was because of our respective doctors.

    The first time I was in the hospital there was a full staff. The last time I was in the hospital they had RNs doing work that once fell to the nurse's aides. That is absolutely wrong.

  2. Try paying a insurance premium now. The cost has skyrocketed; I know this has been reported ad nauseaum on television reports. Your doctor now schedules twice as many patients in one day to compensate for the pay he used to receive on 1/2 those many patients. Don't expect to spend more then 15 to 20 minutes with that specialist. Those heart patients? Quaintly called "fast tracks" to get them in and out of the hospitals....scary when they have just had open heart surgery and are out of ICU in one day.


Comments are moderated to prevent spam posters. Leave a comment! It's nice to know you visited!