Wednesday, July 4, 2012

Fines, Fees and New Regs.

I have some ideas on how to make the "Affordable Care Act" work in our favor if it doesn't get tossed out.  Whether this act does get overturned or not, these ideas could be the start of reining in excesses in medical care.

The number one thing on my list is to get rid of the "Amnesia For All" sedation mentality.  Only a very few patients need this, and they can pay for it out of pocket.  Versed "sedation" in particular should be out of the question for most patients.  Propofol has a much better track record.  It will cost more money, but hey, if the patient wants to be sedated, they can pay for it. 

I want some teeth in the "informed consent" laws.  I want there to be FINES involved with breaches of the law.  I pick a nice round number, $10,000 for EACH VIOLATION!  $5,000 to the victim and $5,000 to be split between the whistleblower (if any) and the government health care fund.  The whistleblower shall be anonymous or immune from being fired, whichever the health care worker wishes.  Let's get our "patient advocates" which are supposed to be our nurses back on our side.  Let's CUT those costs by not only ensuring that the patient gets no more medical treatment than they want or need AND capturing those fines, fees and penalties for excessive treatment!  It's a win, win situation!

The government can MANDATE what information is given to the patient.  In the case of "sedation" the risks of sedation which are many shall be spelled out.  The word AMNESIA will be featured prominently in bold face type at the beginning of the document or a $10,000 fine.  It will also contain verbiage about unnatural obedience.  The admissions that Versed has been known to cause PTSD type reactions to it, including depression, insomnia, rage and permanent memory loss shall all be documented as possible risks of "sedation."  Any deletion of even one of these risks, which are well known to medical personnel will cause a $10,000 dollar fine to be levied against the anesthesia provider, the physician AND the treatment center.  This consent shall be SEPARATE from the surgical consent.  If the "sedation" is being provided as a patient borne expense this should be easy.  We can simply decline to sign it.  It would be shown to the patient as an OPTION at their own personal expense. 

Informed consent for sedation should also include the FACT that by consenting to sedation, the patients right to stop the procedure for any reason will be compromised.  We do have the right to stop the procedure at any time even after beginning.  We need to find a way to enforce this.  If a sedated patient is screaming or writhing in pain, this pain must be addressed before the procedure continues.  $10,000 dollar fine for not stopping when the patient is in agony, whether or not the patient has been given amnesia.  Nurses who step up to the plate while their patient is on Versed and may or may not remember the abuse, share the money. 

IF any anesthesia nurse working in a non opt out state works without the supervision required by law, another 10,000 dollar fine.  The anesthesia group that they work for will also be getting a $10,000 dollar fine for each time a nurse works without supervision, which can be detailed about what that supervision consists of.  ACTUAL supervision, not the deliberate flouting of the law now experienced.  Right now, anesthesia nurses are claiming that the LAW as it pertains to supervision is only a billing ploy.  This is FRAUD, and should have some more fines fees and penalties levied against each provider that claims a supervisor when in actuality the anesthetists are performing autonomously.  The entity who is allowing this to happen, to include the anesthesia group and the treatment center shall also be fined $10,000 per violation.  Include the insurance carrier in the sharing of the fines, fees and penalties involved with the fraud, if any of them were harmed by the fraudulent billing for a supervisor which was never there, but billed for anyway.

I could really get into this!  What about those instances where the patient has been given things which they expressly forbade?   In my case, I expressly declined any sedation type drug and general anesthetic.  That's at least $20,000 dollars I would get a share in.  Possibly more as I can document several SEPARATE times that Versed was given to me!  The NURSE injected me with that "vitamin v" at the instruction of the crna.  Maybe SHE should be fined as well, for injecting me when she knew that I had declined such intervention? 

The alleged informed consent I signed did not contain any risks or benefits.  Who knows how many items that might entail?  The phony informed consent I signed did not have ALL (actually it didn't have any) the people who would be involved in my care listed along with their job description as required by law.  I counted 17 people that I didn't know who they were and what they would be doing to me!  That fine would be $170,000 dollars!

What about my crna who failed to tell me that he was a nurse or that he would be in charge of my anesthesia?  He never gave me the option of demanding a real physician for my anesthesia either!  That's $30,000 from him, $30,000 from Anesthesia Associates and $30,000 from the treatment center.  Now we're starting to get somewhere.

A woman has alerted me to the fact that healthy uterus's are being taken by surgeons.  There need to be hefty fines for this.  There are ways to tell whether a uterus can be saved or not.  Let's fine people for taking out healthy organs.  Let them prove that they were doing all this extra surgery in good faith and not trying to bilk the insurance or government program!

Caps on advanced practice nurses salaries.  CEO's are getting hammered by the government for their inflated salaries, let's go after these nurses and THEIR six figure salaries.  If they want to be doctors, let them pay the price and go to school for it.  IF we are going to have nurses do the doctors light weight stuff, then they need a light weight salary commiserate with their station.  There should be a SAVINGS for allowing lesser skilled people perform tasks.  After all there is a paucity of gp's right now, or so they say.  If there were some bigger salary differences I'm positive that more decisions would be made by potential health care workers to go the doctor route.  Don't you think?

Anyway, there are about a million things that could be done to ameliorate the damage that this "Affordable Care Act" does.  Legislators love to legislate and mandate stuff, so let's get them going!  Call your elected representatives.  Outline some of your own cost saving and revenue generating methods for consideration!

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