bobanddenisewanderlust

Saturday- We did our usual Saturday morning chores. Lunch was leftover Chinese from last evening. After lunch, we took a nice nap. I really need to catch up on lost sleep from the week on the weekends

At 2:40 we left for our trip to LaPlata. The beltway was backed up all the way to College Park from the Redskin game. We knew there was going to be increased traffic, but it was really slow. Of course, people are crazy. All day there was rain predicted, so what do we see, but as soon as it starts to rain, there is a idiot pulled over on the shoulder, stopped to put up the roof on his Corvette. You knew it was going to rain! It had  been sprinkling on and off all day, so duh, don’t run with your roof down!

Then there were the inevitable idiots who are drinking and have to stop on the shoulder to relieve themselves!

We decided to go around  the traffic, so we took 50 east to Bowie, then 301 from there. Bowie was also a parking lot. Partly because of one traffic light and partly because everyone else was trying to do what we were doing. Once past Bowie, the traffic  became heavy, but moving, until we reached Brandywine, where it was backed up again. Since they have put in the new shopping center in Brandywine and started building all those houses in the area, the traffic comes to a standstill in both directions. Once we were past the shopping center, the road cleared out and we sailed to La Plata.

Thank you Lorrie and John for hosting this get together. It was wonderful to see our  old friends. Of course there was Lorrie and John Anderson, Gary and Sharon Sunderland, Kathy and Bill Neblett, Doug, Chin-Zen and Lindsey Plotner, Jeanette and Jimmy McCulley, and Vicki Williams ( who left and came back with her granddaughter). 

Dinner was great, with chicken and ribs from Texas Ribs and pot luck for the sides. Sharon had brought an awesome refrigerator strawberry dessert. ( thanks again for the recipe Sharon!).

We played Mexican Train with lots of laughter and teasing. The ride home was uneventful.

Sunday- We did our usual Sunday chores, then took off at 10 to meet friends Mary Nachman and Beth Woodward at for brunch  in Arlington at   Whilow’s on Wilson.

Wow, has the Clarendon area of Arlington changed. The only thing I recognized was Mario’s Pizza, an old high school hangout, which seems to have survived the years.

We returned to Cherry Hill. The ride home seemed to take forever due to the traffic. It was almost 3 when we arrived back. Bob took the dogs for a quick walk, then headed over to the office to work. He ended up life guarding, again, as well as guiding people to their sites, doing some repairs, and driving the tractor.

I worked on putting items up for our move.

Monday-  It was not too bad a day at work. Bob drove the tractor in the evening.

Tuesday-  Bob picked me up at work and just  as we were approaching Cherry Hill RV Park, we could see a motor home turning out of the park, onto Cherry Hill road. Both of us noticed, at the same time, that the big awning, on the passenger side, was out. Bob started blinking the headlights, rolling down his window to wave and I was frantically waving from the passenger side through the windshield at the motor home driver. We caught their attention, so the driver pulled over. He did hit some limbs with the awning, but it looked okay. It appeared his awning is electric, and we think they might have accidently hit the switch or something else went wrong with it. Either that, or they had not looked up during their walk around, or they did not do a walk around before leaving.  We both do a walk around before we pull out of a site to make sure that we have everything in place or that we have not forgotten anything. It is really easy to drive off with the water or electric still connected or the TV antenna still up. You see it happening all the time!

Bob drove the tractor this evening.

Wednesday-  A little busier at work today. Bob drove the tractor in the evening and we have both been working on getting the motor home ready to move

Thursday-Another, fairly quiet day at work. Bob worked from 10-2, as the lifeguard. He said that if he had to be a lifeguard full time he would be suicidal! It was much too boring.  Of course there was one kid he had to speak to. The kid kept doing a “dead man’s float’, so Bob told him to at least move his arms so that he knew he was still alive. The kid looked at him like he was crazy!

At work, they gave Tammy and I a going away party. Tammy is another traveler and it was her last day. Thanks everyone, it was so nice. They even had a cake from “ Cakes by Jerard”. This is a yellow cake, with fresh strawberries, white chocolate frosting with white chocolate shavings. It is one of my favorite cakes and they had it at my going away party two years ago. Thank you EG and Dee for arranging the party, and thank you Isabella, for arranging the cake!

We both worked on getting the motor home ready to travel then Bob drove the tractor for one last time.

Friday- MY LAST DAY OF WORK! I  have been counting the days, now I started counting the hours. I was kept busy, trying to get as much done as possible, since it is a holiday weekend and next Tuesday is going to be an extremely busy day.

I finally decided that the best way to describe Hospital Case Management is to compare it to a video game. The patient is your Avatar, and you have to move the Avatar through the levels of the game. The levels are home with transportation, home with home health, and /or DME( durable medical equipment), Sub-acute Rehab, Acute Rehab, or LTAC( Long Term Acute Care ). The object, is to facilitate a safe and effective discharge, while getting the hospital paid and keeping the length of stay down.

There are rocks that you have to pick up and carry while moving. These are the 48% of the patients that have no insurance.  You still have to make arrangements for these folks, without the advantage of a payer. You are required to do so, by law, as you have to perform a safe discharge.

There are a lot of brick walls! Behind these walls there are the insurance Case Managers, who jump out with  Uzi’s and shoot down your discharge, because the insurance company is declining to pay for whatever service your Avatar needs. ( Again, I say, avoid Kaiser!)  Or, the Home Health Agencies, who have now decided not to accept anyone who might be involved in litigation. They may not get paid for several years, if it is a car accident, so they will not accept the patient. Remember, I have been working on the Trauma floor of a Level One Trauma Center, so there are a lot of car accidents!

Then there are the Trolls. One type of  Troll are  the Doctor’s who are too busy to dictate the Transfer Summary or are too lazy. Or, they just do not show up to visit their  Avatar for 5-6 days.

Another Troll is Alma, the anal retentive octogenarian  Medicaid Transportation Coordinator for the Prince Georges Health Department. Her form is in  4 pt. font, covering half the page, with little bitty boxes you have to check, on 8 1/2 by 11 paper. If you miss one box, you have to start over! 

Or the Maryland Medicaid system which has a computer program that you have to initiate for payment. It takes forever to get this long, long form completed, within a short time frame. If you take too long, your busted and have to start all over again.

The same thing occurs with the ambulance transportation system. You have to do it in the SMS computer system and it dies in the middle of your set up, and you have to start over again. Cussing and screaming at the computer does not work!

Then of course, you have all this ‘playing’ to do, while also completing Utilization Reviews, which are explanations to the insurance companies, why the Avatar was admitted and justifying the stay.  To make it fun, the insurance companies change their fax numbers, without notifying you, then deny payment since you did not get the review to them in a timely manner.  Or the patient actually has insurance, but you don’t know about it until the person is gone and you have to go to Medical Records to get the information to do the review. A lot of guessing goes into this and if you are smart, you do a review, just in case….

I mustn’t forget InterQual, the great lordly overseer of standard of care and length of stay, who has decided that all Avatars are identical.  To justify the Avatar staying in the ‘game’, you  have to qualify them in the InterQual computer program, making a little  box, turn from red to green. Even the Kaiser liaison was banging on her computer and muttering  while trying to make her Avatar turn colors! Do I need to explain that Avatars (people) are all different and do not fit into nice, neat little boxes! Especially, when the program doesn’t take into fact  items like chest tubes( for a collapsed lung).. So I learned to ‘cheat’, and use the 2011 version, where more Avatars qualify, than the 2012 version, where only 1-2 Avatar’s qualify! Ah, the joys of game! Then of course, there are the Doctor’s who come in and casually say “ Make it so”, thinking that all of this just occurs, without any preparation, and all we do is sit around pecking on the computer or chatting on the phone! You do have lifesavers in the rest of your team, the Physician Assistants who are very under utilized by the Doctors,  Physical Therapist, Occupational Therapists, Speech Pathologists, and of course the nurses.

Woops, almost forgot about “Observation”. You might have read about this, as there has been a lot of press discussing this issue. It started with Medicare( doesn’t everything?) When you come to the hospital, if the doctor thinks that you are going to be in the hospital for less than 24-36-48 hours, then you are placed into “Observation” status. The Avatar has no idea that they are in ‘Observation”. They are in a bed, get three meals a day(maybe), they are going for tests and the nurses are taking care of them. Technically, they have not been admitted to the hospital. If they are in this status, the hospital gets paid a set rate and the insurance pays that set rate. If they are admitted, then the hospital bills for each individual service . If the Avatar is in Observation, they get a lot of bills for the prescriptions and other services,that if they are admitted, they are not responsible for these bills. Hence, the stories in the media about this.  If the doctor guesses wrong, the hospital does not get paid at all, if is determined that the patient should have been in observation status or if the patient is changed from Observation to full admission, and discharged in less than 24 hours from the full admission order.

So this complicated system is like a video game, with live people who require services and a system which is set up to deny them what they need! While I will miss PG Hospital, and all the terrific people I have been working with, I will not miss the actual work!

We went out to dinner at the Shanghai Seafood Buffet, then put everything left out away. We plan to hit the road very early in the morning to avoid the traffic.

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