“It seems like a lot of stuff here is just weird,” said the student.
“What do you mean?” asked the master.
“I mean, everywhere I look there are posters about Quality Experiences and We Care. Even your badge lanyard says “PROVIDING QUALITY CARE FOR 75 YEARS.” But it seems like everybody hates their job. The policies are really weird. It just doesn’t seem like the hospital I expected.”
“Let me explain it to you,” said the master. “The hospital is a business.
In order to run, it needs to generate money. To generate money, we need to bring people in, but we can’t go out making people sick because it would be unethical. Plus, people who are sick are often poor, and we get minimal reimbursements: one diagnosis is paid one amount by the Medicare Gods.”
“Go on,” said the student.
“So the only way for us to make any money is on patients with complex diagnoses. They’re called ‘outliers.’ If you come in with Pneumonia, the hospital gets a flat rate–say $10,000. But! If you come in, and in addition to the pneumonia it is discovered that you have COPD and Diabetes and Heart Disease and Renal Failure, you become a more complex patient and the Gods will pay you a higher rate for the services provided.
So it follows that it’s in the hospital’s best interest to over-diagnose people. If you can do some tests and find some other problems with people, you can make more money. That’s why we do so many bullshit tests on people; it makes us some sweet, sweet moolah. And the elective procedures? That’s where some of the real money is. The plastics guys, the cardiac guys, they’re the ones generating the serious revenue.”
“That seems so wrong! We should be doing things scientifically, not based on some random formula that tells us how much money we get for different things. What about the patients?”
“The patients don’t matter. They are pawns in the game, and the ultimate goal is to fatten the wallet of the Board of Directors. We’re not for-profit, but the Board and the upper managers are sort of shareholders…the size of their bonus depends on the profits. You know how nobody got a raise last year? Our manager took home $15,000 dollars because of that, and the CEO got a $245,000 bonus last year.”
The student frowned. “I thought that people who said that were just being bitter…”
“Nope. It’s true.”
“So how can they talk so much about care? The CEO here is always in the news talking about the Mission of the hospital and how glad he is that we can care for the patients.”
“It’s just marketing. It’s just pretty signs and catchy slogans. The reason we market aggressively is to get the audience for those elective procedures and to create an atmosphere of trust. Once these people are through the door, we have them. That also is why we have an army of middle managers: patients in general have no idea if their care is good or bad, but they’ll remember it if someone with a big title and a suit comes around and smiles at them for a while. They’ll ask them a few vague questions, make some ambiguous promises, and then leave. Back to the office!
But really, nobody gives a shit about these people. I mean, the bedside staff…the nurses, the RTs…a lot of us still care, but it’s so hard to do the right thing when you’ve got ten useless managers breathing down your neck screaming about cost-containment and doing the paperwork right. People get fired for doing paperwork wrong, but you can kill a patient and not get in any trouble. There’s no reward for treating people well, but there are a lot of rewards for playing the game. It creates the wrong incentives.”
The student looked horrified.
“So what do you do?”
“I find solace in the little things. Most of what I do does not matter. In the ICU it’s mostly hopeless cases or people who are beginning the death spiral, so I try to be the best therapist I can with the patients I can actually help. I’ll help someone move in the bed and get comfy, or fill their ice pitcher. I’ll help them eat or help them get positioned so they can eat; you’d be shocked how many nurses dump the food tray on the bedside table and then leave with the patient unable to eat. They have six other patients to dump food on too.”
“That’s it then, huh?”
“More or less. Most of this stuff is pure bullshit, but they pay us to do it, so I guess the trick is…do the best you can for the people you can actually help. Even the small stuff can make a difference, and you should relish those opportunities, because they only come along every so often.”
:::::::::::::::::::
Not an inspiring tale, dear readers…but that’s more or less how it is.
“It seems like a lot of stuff here is just weird,” said the student.
“What do you mean?” asked the master.
“I mean, everywhere I look there are posters about Quality Experiences and We Care. Even your badge lanyard says “PROVIDING QUALITY CARE FOR 75 YEARS.” But it seems like everybody hates their job. The policies are really weird. It just doesn’t seem like the hospital I expected.”
“Let me explain it to you,” said the master. “The hospital is a business.
In order to run, it needs to generate money. To generate money, we need to bring people in, but we can’t go out making people sick because it would be unethical. Plus, people who are sick are often poor, and we get minimal reimbursements: one diagnosis is paid one amount by the Medicare Gods.”
“Go on,” said the student.
“So the only way for us to make any money is on patients with complex diagnoses. They’re called ‘outliers.’ If you come in with Pneumonia, the hospital gets a flat rate–say $10,000. But! If you come in, and in addition to the pneumonia it is discovered that you have COPD and Diabetes and Heart Disease and Renal Failure, you become a more complex patient and the Gods will pay you a higher rate for the services provided.
So it follows that it’s in the hospital’s best interest to over-diagnose people. If you can do some tests and find some other problems with people, you can make more money. That’s why we do so many bullshit tests on people; it makes us some sweet, sweet moolah. And the elective procedures? That’s where some of the real money is. The plastics guys, the cardiac guys, they’re the ones generating the serious revenue.”
“That seems so wrong! We should be doing things scientifically, not based on some random formula that tells us how much money we get for different things. What about the patients?”
“The patients don’t matter. They are pawns in the game, and the ultimate goal is to fatten the wallet of the Board of Directors. We’re not for-profit, but the Board and the upper managers are sort of shareholders…the size of their bonus depends on the profits. You know how nobody got a raise last year? Our manager took home $15,000 dollars because of that, and the CEO got a $245,000 bonus last year.”
The student frowned. “I thought that people who said that were just being bitter…”
“Nope. It’s true.”
“So how can they talk so much about care? The CEO here is always in the news talking about the Mission of the hospital and how glad he is that we can care for the patients.”
“It’s just marketing. It’s just pretty signs and catchy slogans. The reason we market aggressively is to get the audience for those elective procedures and to create an atmosphere of trust. Once these people are through the door, we have them. That also is why we have an army of middle managers: patients in general have no idea if their care is good or bad, but they’ll remember it if someone with a big title and a suit comes around and smiles at them for a while. They’ll ask them a few vague questions, make some ambiguous promises, and then leave. Back to the office!
But really, nobody gives a shit about these people. I mean, the bedside staff…the nurses, the RTs…a lot of us still care, but it’s so hard to do the right thing when you’ve got ten useless managers breathing down your neck screaming about cost-containment and doing the paperwork right. People get fired for doing paperwork wrong, but you can kill a patient and not get in any trouble. There’s no reward for treating people well, but there are a lot of rewards for playing the game. It creates the wrong incentives.”
The student looked horrified.
“So what do you do?”
“I find solace in the little things. Most of what I do does not matter. In the ICU it’s mostly hopeless cases or people who are beginning the death spiral, so I try to be the best therapist I can with the patients I can actually help. I’ll help someone move in the bed and get comfy, or fill their ice pitcher. I’ll help them eat or help them get positioned so they can eat; you’d be shocked how many nurses dump the food tray on the bedside table and then leave with the patient unable to eat. They have six other patients to dump food on too.”
“That’s it then, huh?”
“More or less. Most of this stuff is pure bullshit, but they pay us to do it, so I guess the trick is…do the best you can for the people you can actually help. Even the small stuff can make a difference, and you should relish those opportunities, because they only come along every so often.”
:::::::::::::::::::
Not an inspiring tale, dear readers…but that’s more or less how it is.