Stopping Elective Cases

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They are all modifiable risks that lead to detrimental health consequences, and health care costs.

I made no judgement, nor claims of character defects. Didn't even equate the two. Simply countered the hyperbolic argument that paying for modifiable risk factors is unprecedented. Far from unprecedented, it's a major part of the business model.

Many of these risk factors are societally driven, as is the reluctance to get vaccinated. The government's fumbled handling of this pandemic has a large role in building the mistrust in the vaccine that we are witnessing.

My job is to care for all, with compassion, not make judgements and discriminate based on people's poor choices or modifiable risk factors. I trust that the people in here, who are suggesting we deny care to the unvaccinated, are merely expressing their understandable frustration, and not seriously advocating for discrimination.
 
periopdoc said:
They are all modifiable risks that lead to detrimental health consequences, and health care costs.

I made no judgement, nor claims of character defects. Didn't even equate the two. Simply countered the hyperbolic argument that paying for modifiable risk factors is unprecedented. Far from unprecedented, it's a major part of the business model.

Many of these risk factors are societally driven, as is the reluctance to get vaccinated. The government's fumbled handling of this pandemic has a large role in building the mistrust in the vaccine that we are witnessing.

My job is to care for all, with compassion, not make judgements and discriminate based on people's poor choices or modifiable risk factors. I trust that the people in here, who are suggesting we deny care to the unvaccinated, are merely expressing their understandable frustration, and not seriously advocating for discrimination.
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I said the situation with covid and the vaccine has no precedent in health insurance with the way non-compliance of preventive measures has been borne. If we're being specific about it, that statement remains accurate since this is the first deadly global pandemic in the age of modern health insurance with a known 90%+ effective preventive measure.

If you're being pedantic about it, you can try to equate the circumstances of covid/the vaccine with compliance to losartan, lipitor, and an aerobics plan in the effort to prevent a CVA or MI which might or might not happen in 25 years anyway......but I think we all know it's not the same thing since there are extreme degrees of modifiable risk factors requiring variable patient effort and with variable associated absolute risk reduction. Smokers have just a 3% absolute risk of lung cancer while non-smokers have a 0.4% absolute risk. The relative risk is much higher with smokers, but at the same time quitting smoking is nearly an impossible task and usually takes multiple tries with extensive pharmacologic and psychological help.

On the other hand, 95% of covid hospitalizations (which are causing a public health crisis in many parts of the country, e.g. look at the ICU tents currently set up in Mississippi), are in people who couldnt spend 15 minutes to receive a free vaccination. Yes, I guess both smoking and covid vaccines are technically "modifiable risk factors " but trivially pointing that out misses the bigger issue.
 
periopdoc said:
My job is to care for all, with compassion, not make judgements and discriminate based on people's poor choices or modifiable risk factors. I trust that the people in here, who are suggesting we deny care to the unvaccinated, are merely expressing their understandable frustration, and not seriously advocating for discrimination.
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Get off your high horse. These are attending conversations and not doe eyed 23 yr old medical students in ethics 101. We know the ****ty state of the US medical system and can speak freely. Don't forget that one of core principles of medicine is Justice. There is no justice currently for those with legit medical issues being bumped or delayed by jackasses who are not taking the vaccine and decompensating. Those are the patients I am advocating for.

Discrimination exists all over medicine. Triage is another form of discrimination since we dont have endless resources or personnel (see burnt out and quitting nurses and docs). It's not about denying care to the unvaccinated. Its about triaging them to the back of the line due to their self imposed consequences.
 
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coffeebythelake said:
www.businessinsider.com

Doctors in North Texas considered taking COVID-19 patients' vaccination status into account when determining who got ICU beds

A North Texas Mass Critical Care Guidelines Task Force spokesperson has since rowed back on the memo on how to triage patients.
www.businessinsider.com www.businessinsider.com

www.nbcnews.com

Alabama doctor pledges to stop treating unvaccinated patients

Dr. Jason Valentine said in a letter to patients that he could not watch more of them "die from an eminently preventable disease."
www.nbcnews.com www.nbcnews.com
Click to expand...
And predictably the Texas task force is getting lambasted for it and walking it back.
 
Robotic Wis-Hipple said:
And predictably the Texas task force is getting lambasted for it and walking it back.
Click to expand...

of course the optics of it look bad especially in a conservative state like Texas where lots of *******es refuse the vaccine,

but from a medical/ethical standpoint i get what they are saying

when you work with a critically limited resource such as ICU beds, ventilators, and trained staff tough decisions have to be made in triage

in my mind, an unvaxxed patient with severe covid is not dissimilar to an alcoholic cirrhotic wanting a liver transplant
 
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In a way this covid crisis is a test that has provided a clear example of how totally ****ed healthcare is in this country. Everyone pisses and moans over the costs of healthcare and there will be a reckoning one day where we can’t keep doing unlimited healthcare in everyone no matter what, but that day is in the future and for someone else to deal with…Until covid came.

Now we have a legitimate health crisis causing emergency surgery delays, delays in important elective surgeries, decline in icu care quality due to strained staffing ratios etc. People with easily survivable issues are receiving either substandard or no care because the healthcare system is full of the slackwits who cared more about their machismo perception of freedom than they did about keeping the healthcare system functioning.

We didn’t run out of vents we ran out of people who know how to care for patients who need them. The same people who are told to pretend that the full code 80 year old with severe viral pneumonia, aki, shock should get the same care as the 48 year old with just viral pneumonia. We have to board the 48 year old in the Er as she clinically declines unnoticed for hours while the 80 year old is getting proned and hooked up to the last crrt machine in the hospital just because he showed up a few hours earlier, better luck next time Jane!

This country is completely incapable of handling a crisis—we have become a huge bunch of entitled babies living off the coattails of the accomplishments of the generations before us. The people on the ground say they need to get rid of the doomed cases to make room for people they can actually help and just get told no help everyone instead, that it is unethical to ration care or do anything that remotely acknowledges the clinical reality that has been beaten in to the icu workers over the past 18 months.
 
Zekchar said:
Get off your high horse. These are attending conversations and not doe eyed 23 yr old medical students in ethics 101. We know the ****ty state of the US medical system and can speak freely. Don't forget that one of core principles of medicine is Justice. There is no justice currently for those with legit medical issues being bumped or delayed by jackasses who are not taking the vaccine and decompensating. Those are the patients I am advocating for.

Discrimination exists all over medicine. Triage is another form of discrimination since we dont have endless resources or personnel (see burnt out and quitting nurses and docs). It's not about denying care to the unvaccinated. Its about triaging them to the back of the line due to their self imposed consequences.
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At my hospital those physicians caring for Covid patients on ventilators are already doing their own triage behind closed doors. I think you know what I mean without elaborating any further. I suspect the same thing is going on at many/most hospitals across the country.

Also, we are still doing urgent cases so the truly medically needy are NOT being denied/delayed care.
 
The medical bills of the unvaccinated is to the tune of billions of dollars per month and the vaccinated population is subsidizing it. All preventable cost. And these are very conservative figures.
www.healthsystemtracker.org

Unvaccinated COVID-19 hospitalizations cost billions of dollars - Peterson-KFF Health System Tracker

COVID-19 vaccines have been free and broadly available to adults in all states and the District of Columbia since mid-April 2021, meaning adults in the U.S. have generally been able to be fully vaccinated for COVID-19 since late May 2021 if receiving a two-dose vaccine. COVID-19 vaccines are...
www.healthsystemtracker.org www.healthsystemtracker.org
1629506990662.png
 
Ezekiel2517 said:
The medical bills of the unvaccinated is to the tune of billions of dollars per month and the vaccinated population is subsidizing it. All preventable cost. And these are very conservative figures.
www.healthsystemtracker.org

Unvaccinated COVID-19 hospitalizations cost billions of dollars - Peterson-KFF Health System Tracker

COVID-19 vaccines have been free and broadly available to adults in all states and the District of Columbia since mid-April 2021, meaning adults in the U.S. have generally been able to be fully vaccinated for COVID-19 since late May 2021 if receiving a two-dose vaccine. COVID-19 vaccines are...
www.healthsystemtracker.org www.healthsystemtracker.org
View attachment 342381
Click to expand...
Very conservative. The survivors are all on disability (if they are working age) + ballooning rehab costs, home oxygen, additional load on PCPs/pulmonologists. When all is said and done it will be a staggering figure. Not to mention the loss of life and productivity in the younger folks.
 
Ezekiel2517 said:
The medical bills of the unvaccinated is to the tune of billions of dollars per month and the vaccinated population is subsidizing it. All preventable cost. And these are very conservative figures.
www.healthsystemtracker.org

Unvaccinated COVID-19 hospitalizations cost billions of dollars - Peterson-KFF Health System Tracker

COVID-19 vaccines have been free and broadly available to adults in all states and the District of Columbia since mid-April 2021, meaning adults in the U.S. have generally been able to be fully vaccinated for COVID-19 since late May 2021 if receiving a two-dose vaccine. COVID-19 vaccines are...
www.healthsystemtracker.org www.healthsystemtracker.org
View attachment 342381
Click to expand...

Our hospital system alone lost about a billion last year from covid.
 
chessknt said:
Lol I used the same n95 for a month last year and we had reusable gowns their Ppe budget was probably under 1k
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When you're putting all these jokers on remedesivir and ecmo, things get expensive fast

There was literally zero triage, we were tubing 90 year olds and 50 bmiers like vents, meds and staff were plentiful
 
chessknt said:
Seems like a flaw that a building and business designed to take care of sick people loses money when it does exactly that though…
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aren't they getting a flat fee for a diagnosis code? Incentivizes the hospital to be as efficient as possible to maximize profit. Then when the patients have prolonged stays the hospital loses money. Covid patients stay so long and use so many resources they are a huge money loser to the hospital. I think last year they were able to get reimbursed for all the expenses on those patients but not sure that is still the case.
 
dhb said:
Did the CEO get his bonus though?
Click to expand...

Actually yes, the "executive team" took their god given bonuses as usual. But they took away our exparel and ofirmev. Government intervention helped limit our losses to only hundreds of millions.
 
ChiDO said:
Our CEO got his $15m bonus last year. But we can't hire enough staff to run our ORs now, so all cases must be done by 3pm. Oh, and no more flip rooms for ortho.. No one to staff them.
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What medical system? That's gotta be a bad idea/look if the media gets wind.
 
ChiDO said:
Our CEO got his $15m bonus last year. But we can't hire enough staff to run our ORs now, so all cases must be done by 3pm. Oh, and no more flip rooms for ortho.. No one to staff them.
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Our ORs are also hurting for staff which makes things seriously painful for the call guy and the hospital surgeons who have to do all the addons late in the day back to back
 
GassYous said:
Our ORs are also hurting for staff which makes things seriously painful for the call guy and the hospital surgeons who have to do all the addons late in the day back to back
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Yup. Our system pushed too hard on keeping CRNAs past their shifts....so a bunch gave notice recently. Worsening the problem. Finally got Administration's attention.
 
Airway said:
What medical system? That's gotta be a bad idea/look if the media gets wind.
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Pick one, any one. Just throw a dart at a map.

I’m pretty sure I don’t work at the same places as the above posters but we’re having the same OR problems and our CEO has received similar compensation.
 
thinkorswim said:
Pick one, any one. Just throw a dart at a map.

I’m pretty sure I don’t work at the same places as the above posters but we’re having the same OR problems and our CEO has received similar compensation.
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We had 19 new grad ICU nurses start last year. At 1 year, 12 had left, 7 with plans to find work outside of medicine (including returning to school for many). Like many others, our hospital is suffering from worker shortages. Paying large amounts has not fixed the issue. ICU is using Travelers, >10k bonuses, retention bonuses, increased base rates. Floor, OR, and periop nurses are less so, but still having cash thrown at them. ****, I’m even buying dinner more and being pleasant to them for a change.

In contrast to others, our CEO turned down a crazy bonus, even though the hospital was quite profitable last year, and has been much more so this year.

Covid stress is real for healthcare workers. It will be interesting to see how the labor markets shake out over the next year. For now it is a great time to be looking for work. For those left doing the work after coworkers have abandoned them, not so much.
 
pjl said:
Covid stress is real for healthcare workers. It will be interesting to see how the labor markets shake out over the next year. For now it is a great time to be looking for work. For those left doing the work after coworkers have abandoned them, not so much.
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Both agree and disagree. Most get paid either salary or hourly. If salaried, the excess work is irrelevant. You have you hours and when they're done you are out. If hourly, the excess work means more hours for more pay. Eventually there is a breaking point. If the admins push too hard then the remaining workers quit and then no cases get done, thus there is only so much they can push.

Know your contract. Know your hours. Know your rates. Know that there are alternative options EVERYWHERE. For the first time in awhile, the workers (vast majority of us) have some leverage. Use that leverage to secure increased pay, better hours, better benefits etc.

My approach is that if I get fired or quit this Friday, I have 2 dozen locum recruiters that can land me a job within 2-3 weeks. That is why I do not give a ****t how my hospital system does. Their problems are theirs. Long as my paycheck comes every 2 weeks and the overtime bonuses continue, I will continue to work. Don't love your job too much.
 
ChiDO said:
They're paying $100/hr for travel scrub techs right now, but won't give current staff raises. It's unreal how piss poor administration is.
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Travelers leave, they’re temporary. As soon as you give raises to the existing circulators etc that salary/hourly rate will be expected to be permanent. I’m not saying it’s right, I’m saying that’s the MBA’s thinking.

But from an RNs perspective, why work in a short handed overworked hospital full of COVID for your normal rate when you could travel and make double? Either way you’re working with COVID, but as a traveler your rate is high, hours very defined, and OT is punishing for the hospital. Seems like a no brainer to me if you are flexible.
 
Robotic Wis-Hipple said:
Travelers leave, they’re temporary. As soon as you give raises to the existing circulators etc that salary/hourly rate will be expected to be permanent. I’m not saying it’s right, I’m saying that’s the MBA’s thinking.

But from an RNs perspective, why work in a short handed overworked hospital full of COVID for your normal rate when you could travel and make double? Either way you’re working with COVID, but as a traveler your rate is high, hours very defined, and OT is punishing for the hospital. Seems like a no brainer to me if you are flexible.
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I'd agree, except that we have had a lot of travelers who have been travelers at our hospital for YEARS! They just keep renewing their contract and usually have to take a few weeks off between each year. I swear, the cost of paying nurses more would be more than made up for in not having to pay travelers tons of money forever and ever AND not having to constantly spend time and money training tons of new nurses to replace the ones that left. It's a terrible revolving door. No doubt costly to keep it spinning.
 
ChiDO said:
They're paying $100/hr for travel scrub techs right now, but won't give current staff raises. It's unreal how piss poor administration is.
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Same as it ever was

Local hospital lured me in to do some locums coverage at $270/h. Just contracted directly with them. They were desperate for cardiac anesthesia coverage. I worked there for a while. It was a great locums gig since I could work from home. No flights, no hotels, great. Everybody won.

Eventually they said that since I was directly contracted they were going to start paying me their PRN employee rate of $210/h. Because that's what they pay. I pointed out that without the locums co middleman and travel/hotel costs, I was a bargain at $270. Nope. I left, haven't worked there in the last 8 months.

They just emailed me asking if I can work next month because they're hard up for staff. Again. $210 is the rate, and that's what it is. I said I'm busy, sorry. I've half a mind to talk to my locums agent and see if she can get me $300/h to work there.
 
pgg said:
Same as it ever was

Local hospital lured me in to do some locums coverage at $270/h. Just contracted directly with them. They were desperate for cardiac anesthesia coverage. I worked there for a while. It was a great locums gig since I could work from home. No flights, no hotels, great. Everybody won.

Eventually they said that since I was directly contracted they were going to start paying me their PRN employee rate of $210/h. Because that's what they pay. I pointed out that without the locums co middleman and travel/hotel costs, I was a bargain at $270. Nope. I left, haven't worked there in the last 8 months.

They just emailed me asking if I can work next month because they're hard up for staff. Again. $210 is the rate, and that's what it is. I said I'm busy, sorry. I've half a mind to talk to my locums agent and see if she can get me $300/h to work there.
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I think it is awesome that you are able to stand up for what you believe you are worth. We all know how much money these people are making, and how much money many of these hospital systems are making.
 
pgg said:
I've half a mind to talk to my locums agent and see if she can get me $300/h to work there.
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Did you work out a deal with a head hunter, or just let them negotiate what they can, pay you $300/hr, and keep the rest?
 
Blockit said:
I think it is awesome that you are able to stand up for what you believe you are worth. We all know how much money these people are making, and how much money many of these hospital systems are making.
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It's easy to say no when I have other options. They have exactly zero leverage. Sadly that's not always the case everywhere.
 
I heard that some ORs were stopped in New York in December and that they are stopping in Ohio. Apparently we are also getting flooded with covid and the powers that be are considering canceling elective cases again.
 
At my shop, covid hospitalization isn't going up that much although the state is seeing a huge rise in the number of infected. We are closing some ORs and cancelling some cases due to staff shortage though. Too many healthcare workers getting covid and getting quarantined.
 
JiPo said:
At my shop, covid hospitalization isn't going up that much although the state is seeing a huge rise in the number of infected. We are closing some ORs and cancelling some cases due to staff shortage though. Too many healthcare workers getting covid and getting quarantined.
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We are seeing no hospitalizations from Omicron. Are others seeing this?
 
GassYous said:
I heard that some ORs were stopped in New York in December and that they are stopping in Ohio. Apparently we are also getting flooded with covid and the powers that be are considering canceling elective cases again.
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We have lots of elective cases that require an overnight admission being cancelled. So far, the only outpatient cases canceled are patients (or their surgeon) test positive.
 
Almost everything cancelled. Combination of hospital full of covid and staff shortages due to covid. Midwest.
 
dr doze said:
We have lots of elective cases that require an overnight admission being cancelled. So far, the only outpatient cases canceled are patients (or their surgeon) test positive.
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Same with us. We just need to tough it out. Omicron, with its more contagiousness and less deadliness, is a godsend at this point. Once everyone has seen it, these ‘brownouts’ in health care won’t be an issue anymore. between the vaccine, monoclonals, paxlovid, molnupiravir, along with fluvoxamine, the vast majority of us will do just fine as we march toward endemic status.
 
OneFellSwoop said:
Same with us. We just need to tough it out. Omicron, with its more contagiousness and less deadliness, is a godsend at this point. Once everyone has seen it, these ‘brownouts’ in health care won’t be an issue anymore. between the vaccine, monoclonals, paxlovid, molnupiravir, along with fluvoxamine, the vast majority of us will do just fine as we march toward endemic status.
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This is only true if we don’t spin off some other mutant variant in the process that combines delta virulence with omicron contagiousness and evasiveness. Giving the virus maximum mutational opportunity is not a godsend.
 
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