Category Archives: Nursing Politics

Apr30

Always a bridesmaid, never a bride.

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During one of my assignments for Policy & Politics in Nursing, I was reading a book (Critical Condition: How health care in American became big business- and bad medicine) for an essay I was required to write (shock! Another essay?!).

Always a bridesmaid, never a bride.

Do you ever wonder where a saying came from? This one in particular came from Listerine. Listerine was actually developed as an antiseptic before it became a commercially sold mouthwash. To boost sales, Listerine hired advertisers to come up with a new angle to sell their product. The advertiser heard a company representative say, “halitosis”— then bam! There’s your new angle. Instead of selling a product, it became a venture to sell sex and beauty.

The ad came out with a bridesmaid holding the bouquet with her head in her hands: “Milly caught the bride’s bouquet but everybody present knew that nothing would come of it… that she wouldn’t be the next to marry in a long ways… and they knew the reason why, too. People with halitosis (unpleasant breath) simply don’t get by. It’s the unforgivable social fault.” (p. 202).

So, in other words, if you have halitosis (or think you do, or there could be a chance that you might develop it by eating an onion, or your cousin has it and you might get it…) you need to swig Listerine. Or you will never be loved or married. Crazy, huh?!

Listerine is actually owned by a big-wig pharmaceutical company: Warner-Lambert. Did you know that the United States is one of the only (if not the only) country that doesn’t allow negotiating with pharmaceutical companies? I found Plavix for $50 in another country, and $200 in the United States. Even MEDICARE can’t negotiate prices with these companies.

I encourage everyone to read this book. It’s an eye opener! Anything from pharmaceutical company madness to Wall Street Medicine. Of course, it’s controversial and provocative- but it’s a good read.

In the mean time, do us all a favor and use Listerine (joking).

Apr9

Political mumbo jumbo.

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It’s been a while since I’ve posted. I’ve been buried under 123,393,234 essay assignments ranging from flu pandemic preparedness, ICU visitation hours, continuous ECG monitoring in ACS patients, and my newest topic: Medicare severely limiting nurse practitioner participation in Accountable Care Organizations (ACO).

My head is still spinning on the politics of it all, especially because I haven’t been trained on billing practices for nurse practitioners. What I’ve learned, however… is that CMS is trying to take NPs back a few years.

Currently, even NPs practicing in independent states have to have collaborative agreements with physicians to bill for care provided to Medicare beneficiaries (correct me if I’m wrong). So, let’s remind ourselves why more and more primary care physicians are not accepting Medicare patients… all those budget cuts, right? So, Medicare finds it necessary for an independently practicing NP to pay a physician for collaboration, despite the poor reimbursements? Sure, dependent states already have collaborative agreements so it’s not affecting but a handful of states. Since most private insurers follow the footsteps of Medicare, essentially this sets the pace for all the other payers. Essentially, you can be an independent practitioner based on your state BON, but you’re not really independent if Medicare has something to do with it. Let’s just forget the IOM suggestions that we utilize APRNs to their full extent. They’re just advisors, right?

Insert Accountable Care Organizations. Nurse practitioners get some recognition and fancy new title, “ACO professional.” Nevertheless, APRNs are severely limited in participating in these ACO’s. If you’re the primary provider for beneficiaries, you must have an ACO physician see your patient for the patient to be counted as a beneficiary in the ACO. So essentially, we’re duplicating services, creating wasteful use of resources, and causing inconvenience to the patient. How is that “affordable” and “accountable?” Also, the CMS regulations for ACOs also restricts nurse practitioner practices from creating ACOs with other nurse practitioner practices.

What’s frustrating is that Medicare is a trendsetter. This kind of legislation makes it difficult to obtain independent practice in our states.

Please correct me if I misunderstood the legislature. Politics has never been my thing… but I’d really like to get involved.

Here are some links to more information:

http://nurse-practitioners-and-physician-assistants.advanceweb.com/News/Front-Center/Final-ACO-Rules-a-Mixed-Bag-for-NPs-PAs.aspx

http://www.aanp.org/NR/rdonlyres/C007705B-D238-426E-83BF-30E6654CB632/5423/ACOFactSheet1111.pdf

http://news.nurse.com/article/20110619/NATIONAL01/106200031

Mar30

Double Standards

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Let me preface this post with: I enjoy making patients happy. Not because the government waves dollar bills above the head of healthcare facilities… Not because hospitals are now coming out with lovely scripts and mind games to make sure the patient knows they are receiving excellent care… And not because my job depends on it thanks to all the geniuses in Congress. I enjoy it because it’s who I am. I’ve been a patient for months on end and a little empathy and compassion go a long way. That being said, when I’m an NP, I don’t plan to replace the lollipop jar with Vicodin for everyone that walks in. My treatment plans will be based on evidence-based practice, assessment, medical history, and experience… Not everyone will get every unnecessary test because Dr. WebMD says that toothache could be cancer. I plan to promote health seeking behaviors and be as compassionate and caring as possible, but 100% patient satisfaction isn’t a reality in any field, let alone medicine/nursing. I won’t support drug seeking behavior, and I won’t support unnecessary radiation with potentially devastating consequences. Sometimes disease processes progress despite aggressive treatment and that can affect satisfaction scores as well. The bottom line is that some patients will only give the highest rating if they get what they want. If that’s courtesy and compassion, fantastic! If that’s requesting unnecessary treatment or prescriptions… I am truly very sorry. I will explain my rationale to you in the most respectful manner and be conscious of your dignity.

Infact, the Archives of Internal Medicine (2012) recently published an article that found that patient satisfaction scores may be linked to increased mortality. The idea behind the article being that provider doesn’t want to say “no”– the patient ends up with more prescriptions, more expensive testing, more admissions, and increased risk of death. More prescriptions mean increased risk of interaction, increased side effects, new symptoms, etc. You can see that article here: http://archinte.ama-assn.org/cgi/content/full/archinternmed.2011.1662

Now all that said… I’ve got a bone to pick. With the new CMS guidelines reduce hospital reimbursements by 2%  for “poor patient satisfaction,” I feel that this should be applied to other areas. For example, when I got my car… my car dealer wasn’t great and the ole Escape isn’t as wonderful as I think it should be. Therefore… I want my reimbursement. Also… getting an oil change or standing in line too long for groceries… I want my 2% break on my bill. Poor housing rates or rude title agency? 2% deduction. I don’t understand why it’s only applicable to healthcare… or maybe we’re just on a slippery slope. Insert conspiracy theory here!

Mar27

Panic Attack!

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As I was looking into articles for my Ethics course, I began finding malpractice cases of nurse practitioners. Don’t get me wrong– I realize that doctors, nurses, pharmacists… EVERYBODY has a chance of getting sued. Then I started thinking… holy smokes! What if I don’t know anything when I graduate?! What if my seasonal-allergies-with-a-cough patient was a pulmonary embolism? My shoulder pain was a STEMI?

I realize that my experience and future education will teach me how to rule disease processes out… I also realize that I haven’t even started my “hardcore” classes yet. I’m still doing ethics and research before I even get to pathophysiology, pharmacology, and health assessment. I haven’t learned anything specific to being a nurse practitioner… yet I feel like I should have the knowledge base of a 30 year NP veteran!

I also found an medical resident website that created a lot of hate and negativity to nurse practitioners. Granted, I realize that some NP’s want to be recognized on the same level as an MD. I just want to work collaboratively- as a team. I didn’t choose NP school because I couldn’t go to medical school. I chose this route because I wanted to be a nurse practitioner since I was in sixth grade! I’m not trying to pretend that I’ll know everything that an MD gets in school and residency. How about a little bit of respect for each other and a little less bigotry (from all ends)? Fortunately, I haven’t worked anywhere with so much animosity. The MD’s and NPs/PAs work really well together in the ED’s that I’ve worked. The NP’s treat the non-urgent patients, screen urgent patients and order tests, and discharge those patients if they don’t require larger work-ups. This has DRAMATICALLY decreased door-to-discharge and door-to-provider times. Patients who would otherwise be in the waiting room for hours without pending tests now have had their ultrasounds and CT scans that were ordered by the NP prior to the patient seeing the physician. If the screening/exams warrant a discharge before they see a physician, this is completed. The MD’s don’t have to do the lacerations… the NP/PA is doing them so that the MD can see critical patients instead of spending half an hour suturing. There’s constant communication, a great flow.

I just hope my first NP job is with a supportive group of associates! If only there were more NP residencies…

Anyway, my panic attack is over :) Why am I worried about someone judging my career choice? And as for the rest… I guess it’s time that I embrace being “green” again. I still remember how “green” I felt when I was a nursing student watching a lap-chole for the first time or thinking I’d never make it through neuro or cardio when I first saw the syllabus. But I did… because I gave myself a chance to learn!

Here’s a cartoon that I found! Bring on computerized-provider-order-entry!

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