Guest guest Posted November 22, 1999 Report Share Posted November 22, 1999 Hi, ... I hale from a NFP SNF...'we' are considered conservative in our approach to patient care...by many paradigms out here, especially per FP. Coming from an acute and IPR and home health perspective over prior years experiences in same (going back to '84-'91), getting 'into' the SNF thing was an eye-opener. At " that " time, SNF settings were able to provide TX based upon DX coupled with therapists' outcome expectations, along with the referring MD's direction. With many an incredible oucome! Today, it's apparent that a LOT has changed...first...the clientele from 'then' are what today we might deem as IPR candidates in overall status; the therapist now must rely on 'appropriate' MD direction and therapist evaluation together-and often one is in conflict with the other. An MD may feel tx is warranted, yet the therapists' payer experiences may deem otherwise. THE payer would likely suggest otherwise. (The consumer appears to be the last to know what the 'rules' are.) Personally, I just finished with a parental (sic!) stay in a local IPR center. The environment today requires a savvy that seems to be borne of 'how can I ensure that that my documentation will ensure that the patient recieves the care required and that my services will be reimbursed and that everthing that's needed is sent at the right time to the right folks and that I'm filling out all the fields in the right way at the right time?', with relentless 'guessing' as to what will be deemed 'necessary' vs. what will be denied. Example: much of our MCB billings are denied when the patient crosses over a billing period for several days (to a week) into the next billing period. (In WI, this billing period is set as the calendar month). Even, when scrutinized, records appear to fully justify medical necessity, there seems to be a tendency to deny when such crosses into the 'next month' (or billing period). Appeals per denials appear to be 'routine' vs an exception. Right now, we are under the PPS for all MCA patients. If therapists were fearful of over-extending services under the 'old methodology', they are even more fearful today. I find it ironic that therapists are now needing to be much more concerned about 'technical writing' (remember when this was not necessarily embraced by payers as per being TOO jargon-related?) and/or more concerned about " how can I write this as to SELL my services? " ...kinda like needing a marketing degree and/or realstate license...where was this in college...did I MISS something???... Further, HCFA continues to enact rules that make it difficult to discern 'medically necessary' even with appropriate diagnoses posed against expected discharge dispositions. Further, it seems that because a patient is IN an SNF, that the outcome of therapy is not necessarily....necessary...even when the prior level of function is well documented, and the goals are simply to approcah the prior level of function. It would appear that if a patient enters the SNF, that the patient does NOT warrant return to prior level of function, nor is necessarily allowed to approach a modified level of independence that approaches PLF, but rather that which would be considered as minimally necessary to turn over to supportive personnel...What about those who have an opportunity to return to 'community settings' or allows some semblance of prior level within the SNF? And what if this means a period of time with restorative before same? (Be careful how and when this intent is phrased, both per MCA and MCB). Further, the PPS seems to have restricted access more than what it seems was initially intended. This may be a hard lesson in some ways...although total number of tx minutes and FIM scores have declined, about the same number of clientele return home. On the other hand, those who must remain in the SNF and are referred to therapies recieve fewer (and less interventions) than what, as a practicing therapist, would feel 'required'. Currently, I am a RS Manager of a 265 bed SNF facility. As part of a larger health care provider, I have the luxury of meeting with 3 other managers of same...with over 500 total beds. We struggle continually with how to achieve our 'in house' therapy departments' service and fiscal viability. With parents now needing some services, it's so very hard to try to explain the limitations on same. I wonder how Bill would have fared under the same 'medically necessary' requirement s under MCA or MCB. (Anyone ever ask him???) I am VERY interested in others' experiences! I welcome any advice from you! Anyone from WI out there??? E.A. Scopp MS-CCC-Sp via Boopsteret@... (okay-NOT the account name-LOL!) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 1999 Report Share Posted November 22, 1999 Kim: Thank you for your warm wishes. We do have much to be thankful for. However, if we could have done things differently 5 years ago maybe we would not have had to go through what has happened with the BBA. Congress looked at the cost of rehab increasing by billions of $ within ~5 years. WE did not respond to this obvious abuse so they did. The only way the " greed of the corporate giants " was allowed to happen was by our complicity. We must not allow people to game the system again this time around. With PPS and the slew of other regulations recently promlugated it will be much more difficult to abuse the system. However, people will find a way to do it. PTs need to be responsible for the services they provide and how thoses services are billed. The days of " I just want to treat my patients and go home " are long over as they should be for that was never what being a professional was all about. kimpt10-@... wrote: original article:/group/ptmanager/?start=8780 > Thank you Jim for putting the context of what was originally said in a better > light. > I would hope that the last two years have taught us something about what can > happen if the Medicare system is abused. Keep in mind that many outstanding > PT's, OT's and ST's who had no other objective than to provide the highest > quality geriatric care to their patients and those therapists lost their jobs > due to the greed of the corporate giants. (I am sorry if that is a little > harsh, but when people like make comments that daily treatments will be > billed month after month, it raises my blood pressure a little bit.) > I just wanted to congratulate those of us who have spent the last almost 2 > years fighting to get the cap repealed as kept many patients from restoring > their prior functional level because their funds ran out and were unable to > continue with treatment. I realized back in April of 1998 that the BBA would > cost many therapists their jobs and fought to get the cap repealed. I wanted > to point out that if we as an association work together, we can make changes. > Let us at least spend a little time feeling good about our efforts before we > start finding ways to make negative comments. > My two cents worth, > Kim Longoria, PT > > 323 Summertime > San , TX 78216 > > Mobile: > Specializing in Geriatric Rehabilitation and Fall Prevention > kimpt101@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 1999 Report Share Posted November 22, 1999 In a message dated 11/23/99 1:36:26 AM Eastern Standard Time, douglaswhite@... writes: << WE did not respond to this obvious abuse so they did. The only way the " greed of the corporate giants " was allowed to happen was by our complicity. We must not allow people to game the system again >> There were many of us DID contact HCFA about abuses. Because of loopholes (perceived or not), the feds did not react in any purposeful way. Claimed they did not set rates and the cost reports were all OK. (This, because of artful accounting and failure of HCFA common sense.) Those of us involved in licensure, ethics, and standards of practice have been crying from the rooftops for years; but no one wanted " to get involved " ; no one wanted to rat on their fellow PTs; all they wanted to do was gripe and have magic happen -- angels on high or somesuch, I guess. So, Doug's " WE " is not universal and all-encompassing. We just did not have enough attention paid to our complaints and concerns. Lucy Buckley PT Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 1999 Report Share Posted November 22, 1999 In a message dated 11/22/99 11:13:06 PM Eastern Standard Time, KDD3800@... writes: << Having spoken to Olsen, legal counsel and lobbyist for the National Association of Rehabilitation Agencies, he believes that the legislation was passed only because industry and professional associations, together with patient groups, worked together for the same goal (for the first time ever, probably). The war is not over, that's for sure, but it's my experience that pessimistic attitudes don't get us very far. We will need to work together >> AMEN! Well stated, Kay! Lucy Buckley PT Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 21, 2003 Report Share Posted November 21, 2003 Thanks for a big smile here . BTW I have a question for someone with kidney concerns. Does it help to drink a lot of water? Does drinking a lot help to prevent kidney disease? I am on very low carbs and have heard from friends this can be haaard on your kidneys. Thanks. Rita Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2003 Report Share Posted November 22, 2003 Yes, drinking a lot of water is good for your kidneys. It helps dilute the potential nasties that your kidneys excrete. Re: happy thanksgiving Thanks for a big smile here . BTW I have a question for someone with kidney concerns. Does it help to drink a lot of water? Does drinking a lot help to prevent kidney disease? I am on very low carbs and have heard from friends this can be haaard on your kidneys. Thanks. Rita Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2003 Report Share Posted November 22, 2003 watch out for anything with phosporick acid in it... that is hard on the kidneys. What is real big on phosporic acid is cola. I.E diet coke/diet pepsi but clear pops like diet 7 up or diet sprite have no phosphoric acid in it. Re: happy thanksgiving > Thanks for a big smile here . > BTW I have a question for someone with kidney concerns. Does it help to > drink a lot of water? Does drinking a lot help to prevent kidney > disease? > I am on very low carbs and have heard from friends this can be haaard on > your kidneys. > Thanks. > Rita > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2003 Report Share Posted November 22, 2003 BTW Rita low carb doesn't put to much stress on the kidneys, perhaps in certain situations but that is why every 3 months you get blood work done and pay attention to your creatine level and your a1c/cholesterol as well. The creatinine is for kidney function and lets you know if you are ok and in range. I call my doc about every 3 months have her write a script for creatine, a1, and cholesterol and then take the script in to the lab and get blood drawn and it done and phone her for the results. Quite easy and really lets me know how I am doing. Re: happy thanksgiving > > > Thanks for a big smile here . > BTW I have a question for someone with kidney concerns. Does it help to > drink a lot of water? Does drinking a lot help to prevent kidney > disease? > I am on very low carbs and have heard from friends this can be haaard on > your kidneys. > Thanks. > Rita > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2003 Report Share Posted November 22, 2003 LOL I would be rising out of the roof and land in the emergency room with a blood sugar of 800! Mehehehe. Heck, I bet to even keep my bgs down to 250 I'd have to take a half of bottle of humalog and then still be high Meheehehe. Just kidding. Please no one take a half bottle of H for thanksgiving, k? LOL Fwd:Fwd:Happy Thanksgiving > > -------------------------------------------------------------- > > -------------------------------------------------------------- > TWAS THE NIGHT OF THANKSGIVING, > > > BUT I JUST COULDN'T SLEEP. > > > I TRIED COUNTING BACKWARDS, > > > I TRIED COUNTING SHEEP. > > > THE LEFTOVERS BECKONED - > > > THE DARK MEAT AND WHITE, > > > BUT I FOUGHT THE TEMPTATION > > > WITH ALL OF MY MIGHT. > > > TOSSING AND TURNING WITH ANTICIPATION, > > > THE THOUGHT OF A SNACK BECAME INFATUATION. > > > SO, I RACED TO THE KITCHEN, FLUNG OPEN THE DOOR, > > > AND GAZED AT THE FRIDGE, FULL OF GOODIES GALORE. > > > GOBBLED UP TURKEY AND BUTTERED POTATOES, > > > PICKLES AND CARROTS, BEANS AND TOMATOES. > > > I FELT MYSELF SWELLING SO PLUMP AND SO ROUND, > > > 'TIL ALL OF A SUDDEN, I ROSE OFF THE GROUND. > > > I CRASHED THROUGH THE CEILING, > > > FLOATING INTO THE SKY, > > > WITH A MOUTHFUL OF PUDDING > > > AND A HANDFUL OF PIE. > > > BUT, I MANAGED TO YELL AS I SOARED > > > PAST THE TREES.... > > > HAPPY EATING TO ALL - PASS THE > > > CRANBERRIES, PLEASE. > > > MAY YOUR STUFFING BE TASTY, > > > MAY YOUR TURKEY BE PLUMP. > > > MAY YOUR POTATOES 'N GRAVY > > > HAVE NARY A LUMP. > > > MAY YOUR YAMS BE DELICIOUS. > > > MAY YOUR PIES TAKE THE PRIZE, > > > MAY YOUR THANKSGIVING DINNER STAY > > > OFF OF YOUR THIGHS. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2003 Report Share Posted November 22, 2003 Thank you . I have been considering giving up pop altogether for a while and your message has helped make the final decision easier. I just signed up for medicare part A and part B. As I have never worked under ss, I have to purchase my own. So with budget and diet considerations I'll be drinking cold clear water which I have always liked anyway. Rita > watch out for anything with phosporick acid in it... that is hard on the > kidneys. What is real big on phosporic acid is cola. I.E diet coke/diet > pepsi but clear pops like diet 7 up or diet sprite have no phosphoric acid > in it. > > Re: happy thanksgiving > > > > Thanks for a big smile here . > > BTW I have a question for someone with kidney concerns. Does it help to > > drink a lot of water? Does drinking a lot help to prevent kidney > > disease? > > I am on very low carbs and have heard from friends this can be haaard on > > your kidneys. > > Thanks. > > Rita > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2003 Report Share Posted November 22, 2003 About 35 years ago my aunt was shot and lost a kidney. her doctor told her no carbonated drinks to save her only kidney. I inow someone else who can drinnk any kind of carbonated drink and be in bed with kidney problems the next day. She thought it might be the cola but tried an orange drink and it still made her sick. Dean What is the meaning of life? Find out on the Masters List: masterslist-subscribe Re: happy thanksgiving > > > > Thanks for a big smile here . > > BTW I have a question for someone with kidney concerns. Does it help to > > drink a lot of water? Does drinking a lot help to prevent kidney > > disease? > > I am on very low carbs and have heard from friends this can be haaard on > > your kidneys. > > Thanks. > > Rita > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 22, 2003 Report Share Posted November 22, 2003 I know what you mean. I had to laugh when I received this E-mail about thanksgiving. Xmas goes the same whay! I am going to Vegas for thanksgiving and will have dinner at my In-laws. so no left overs, which will be a good thing. I don't have trouble eating stuff when I'm out as I pretty much know what to eat and odon't like buffets. In fact, my husband will go to the buffet and I usually order something a little more healthy at the various restaurants where we go in Vegas. Plus all the walking around gives me extra exercise. the only thing I dread is the bus ride there. My husband wil not fly, so we will sit for 6 hours on a Greyhound bus. Ick! Re: happy thanksgiving LOL I would be rising out of the roof and land in the emergency room with a blood sugar of 800! Mehehehe. Heck, I bet to even keep my bgs down to 250 I'd have to take a half of bottle of humalog and then still be high Meheehehe. Just kidding. Please no one take a half bottle of H for thanksgiving, k? LOL Fwd:Fwd:Happy Thanksgiving > > -------------------------------------------------------------- > > -------------------------------------------------------------- > TWAS THE NIGHT OF THANKSGIVING, > > > BUT I JUST COULDN'T SLEEP. > > > I TRIED COUNTING BACKWARDS, > > > I TRIED COUNTING SHEEP. > > > THE LEFTOVERS BECKONED - > > > THE DARK MEAT AND WHITE, > > > BUT I FOUGHT THE TEMPTATION > > > WITH ALL OF MY MIGHT. > > > TOSSING AND TURNING WITH ANTICIPATION, > > > THE THOUGHT OF A SNACK BECAME INFATUATION. > > > SO, I RACED TO THE KITCHEN, FLUNG OPEN THE DOOR, > > > AND GAZED AT THE FRIDGE, FULL OF GOODIES GALORE. > > > GOBBLED UP TURKEY AND BUTTERED POTATOES, > > > PICKLES AND CARROTS, BEANS AND TOMATOES. > > > I FELT MYSELF SWELLING SO PLUMP AND SO ROUND, > > > 'TIL ALL OF A SUDDEN, I ROSE OFF THE GROUND. > > > I CRASHED THROUGH THE CEILING, > > > FLOATING INTO THE SKY, > > > WITH A MOUTHFUL OF PUDDING > > > AND A HANDFUL OF PIE. > > > BUT, I MANAGED TO YELL AS I SOARED > > > PAST THE TREES.... > > > HAPPY EATING TO ALL - PASS THE > > > CRANBERRIES, PLEASE. > > > MAY YOUR STUFFING BE TASTY, > > > MAY YOUR TURKEY BE PLUMP. > > > MAY YOUR POTATOES 'N GRAVY > > > HAVE NARY A LUMP. > > > MAY YOUR YAMS BE DELICIOUS. > > > MAY YOUR PIES TAKE THE PRIZE, > > > MAY YOUR THANKSGIVING DINNER STAY > > > OFF OF YOUR THIGHS. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 24, 2003 Report Share Posted November 24, 2003 ah see that, you are a planner. very good *smile*. regards, Re: happy thanksgiving > > > > > > > > > > > > > > > > > > > > > > > > > Thanks for a big smile here . > > > > > > > > > BTW I have a question for someone with kidney concerns. Does > > it > > > > help > > > > > > to > > > > > > > > > drink a lot of water? Does drinking a lot help to prevent > > kidney > > > > > > > > > disease? > > > > > > > > > I am on very low carbs and have heard from friends this can be > > > > haaard > > > > > > on > > > > > > > > > your kidneys. > > > > > > > > > Thanks. > > > > > > > > > Rita > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 27, 2003 Report Share Posted November 27, 2003 you have a happy thanksgiving as well Shane. We will all be trying to do our best *smile* happy thanksgiving > hi just wanted to wish everyone a happy thanksgiving. this will be my first thanksgiving eating the way i should so i will let ya know how it goes. everyone enjoy yourselves. > shane > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 23, 2006 Report Share Posted November 23, 2006 Thanks Tommie hope you have a Happy Thanksgiving too! Gentle hugs, Debi -- Happy Thanksgiving Wishing you all a very Happy and Safe Thanksgiving! Love and Hugs, ~Tommie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 23, 2006 Report Share Posted November 23, 2006 For all who see God, may God be with you. For all who embrace Life, may Life return your affection. For all who seek a path of truth, may you have the courage to take it step by step. Blessings to you. (a UU prayer) Happy Thanksgiving. a Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 24, 2006 Report Share Posted November 24, 2006 Same to you Halfpint. I hope yours was grand! Hugs ~Tommie Happy Thanksgiving HAPPY THANKSGIVING. I hope you have a GREAT day. Blessings, halfpint __________________________________________________________ Cheap talk? Check out Yahoo! Messenger's low PC-to-Phone call rates. http://voice.yahoo.com Quote Link to comment Share on other sites More sharing options...
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