Thursday, February 13, 2014

Another snow day

I really wanted to go in to work today. I had 5 evals yesterday, and I only completed the paperwork for one of them. I needed to go in. I had planned on going in, to be the token OT in case some of our patients decided to come in- I would be there to treat whoever braved the storm.

But my boss really wants us to stay home if there are no patients to treat (which means using our PTO), because our stats look so terrible recently. And all my morning patients cancelled- and it looks like the afternoon will not be any better. So, all patients were cancelled, and I am staying home. And really, that is how it should be given how it looks outside my window, and given that most if not all of the other outpatient hospital facilities have closed for the day.

The snow is pretty lovely. If I didn't have anywhere to go, it could just be lovely. It is only because of places that I have to be, and schedules that do not follow the rhythms of nature, that it becomes a nuisance.

We have had a lot of snow this month and a lot of cancelled patients. A lot of our patients are older or injured, so they don't go out even when it doesn't seem too bad to us. Maybe they broke their wrist in the last snow storm. I am not impressed by accounting and management in that they don't seem to be able to adjust for the effects of weather on our productivity. The expectations remain the same, no matter how many blizzards we have in a month. Does this make any kind of sense?

Perhaps we need to create some huge artificial intelligence computer system that can lower productivity expectations expectations when the weather is bad. Human managers do not seem capable of doing this wherever I have worked.

But for the moment, I will enjoy my snow day.


Unknown said...

I was reading about one of the periods I have tried not being on lithium and found a post I wrote about getting in trouble for productivity because on one day I drove for 2 1/2 hours to get to a place 25 minutes away from my first facility and then only did minimum treatments because the roads were so horrible. The next day I drove in to one facility so that everyone would at least get a few minutes of treatment, even though the rural roads were awful, but nobody else could make it. The 3rd day I spent extra time doing documentation for the prior 2 days. My productivity was 5% below requirement and they did some slap on the wrist discipline thing that I was humiliated and infuriated by.

I do not miss that part of it. It was part of why I loved home health; I had to get 25 visits in a week which was easy since evals were weighted and if I had to drive huge amounts they considered that but I was so busy it just never was a problem. The rest of the time I always wondered if they truly cared more about my ability to do 2-3 things at once to make more money for them versus my clinical skills.

Have you ever been able to work out what they make off of you? Back before computer documentation I did my own billing and since all OT earnings at my facilities were me I could figure out what they earned, subtract off my salary and be amazed that they could ever consider me "non-productive" when they were earning that kind of money off me.

Just me Jen

Jean Grey said...

I don't know what they collect because so many of our patients have different private insurance companies with different contracted rates- and I don't know what those rates are, only what we bill. And we don't get anything near what we bill. I don't think they are making huge amounts of money. I don't think that Medicare and the insurance companies pay as much for outpatient as they do for home care.

Unknown said...

Home health is done by a set amount for what services are provided as a group and I think acuity which makes it more fair, but I do know that nursing home reimbursement used to add up to a lot. I know there were cuts and they were probably after I had the job where I did my own billing but the only thing I remember is that every eval I did they made a profit of about $45-50. Medicaid did balance it a bit; the reimbursement there was very low. In fact by 2007 they were losing money every time I treated a Medicaid patient. And partly they were making a lot because I wasn't pushing to be paid quite what I should have been (I didn't get good at that until near the end).