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Panacea Financial Contract Review
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FWIW, TH just ended the scribe program at my shop. I don't really mind... they pay me by the hour to chart after shift and the scribes usually messed up the HPI and MDM sections and I had to go back and redo them a lot, resulting in little net time savings.
 
All talk. The western med director sent out a video a few years ago after someone he knew killed himself. It was nice sounding. No changes on the ground. Most ERs are meat processing plants for patients and physicians alike. Many have very high risk features... fewer strokes of bad luck required for all the holes in the swiss cheese to line up.
 
namethatsmell said:
Wait...what? How much do they pay for this?
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Yeah, this doesn't sound right. TH went nuts on me when my partner showed up 30 minutes late and I charged them for an extra half hour of work.

As a matter of fact they recently just sent out an email stating that the only way they would pay for extra hours is if you picked up a patient in that new hour.
 
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Alvarez13 said:
Yeah, this doesn't sound right. TH went nuts on me when my partner showed up 30 minutes late and I charged them for an extra half hour of work.

As a matter of fact they recently just sent out an email stating that the only way they would pay for extra hours is if you picked up a patient in that new hour.
Click to expand...
So pick up a patient and then sign them out. **** em.
 
I work for TeamHealth at my primary job site.
I have not encountered any pushback with respect to extra hours.
When I adjust my hours, I write in the "notes" field something akin to: "Stayed late for [critical care/admission, volume surge/etc]."
We also have 1 doc that is habitually 20 mins late because "California time, brahh", so I document that I'm here late if there's no overlap.

That being said; don't abuse this privilege.
EmCare freaked out on me at my old job site simply for staying to do all my charts, and declared that "all charting must be done within the scheduled shift".
Then, door-to-doc times creeped up across the board, and they bitched about that.
Seeing as how they put us in an impossible situation, our oldest doc freaked out on them and called them out on it.
He retired from clinical practice not long after that, and became an administrator.
You'd think he would champion our cause, right ?
Wrong. He toes that corporate line and now uses the corporate doublespeak that we're "partners" and that it's a "challenge" that you can meet.
I hate those words.

Heed my warning, you Judases who post on here that they "want to go into administration".
Hope you can look yourself in the face and tell yourself that you're "doing the right thing" in a healthcare system that already spends more on administration than physicians.
 
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Alvarez13 said:
Yeah, this doesn't sound right. TH went nuts on me when my partner showed up 30 minutes late and I charged them for an extra half hour of work.

As a matter of fact they recently just sent out an email stating that the only way they would pay for extra hours is if you picked up a patient in that new hour.
Click to expand...
[/QUOTE]

That doesn't sound legal. If they aren't paying you, leave. That's nuts.
 
namethatsmell said:
Do you have a source to back thus up? Would love to use it in an upcoming talk.


Sent from my iPhone using SDN mobile
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20150429_growthinadministratorsopt.jpg



The Great Healthcare Bloat: 10 Administrators for Every 1 U.S. Doctor

i-have-eight-bosses-bob.jpg


Really, all you have to do is google "Administrators Physicians". The results are golden.
 
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namethatsmell said:
Wait...what? How much do they pay for this?



Sent from my iPhone using SDN mobile
Click to expand...

It's like RustedFox said. Just adjust your shift times in Tangier. Multiple people have done this at my shop for years and tell me they have not gotten called on it. It's in our culture to do ~all charting after shift.
 
hundreddaysoff said:
It's like RustedFox said. Just adjust your shift times in Tangier. Multiple people have done this at my shop for years and tell me they have not gotten called on it. It's in our culture to do ~all charting after shift.
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As much as I hate CMGs, it makes me dislike TH a tiny bit less. Glad you are being paid for time you deserve to be paid for.

If only this would catch on everywhere...maybe it would then encourage groups to just improve staffing and overall working conditions so we could finish charting as we go.
 
When working at those sites I chart as I go. I'll stop charting to see unstable patients, otherwise the waiting room can pile up. Staffing the place at a safe level level optimized for concierge care of non-emergent cases while simultaneously caring for the sick isn't my problem, but many of my peers enable the mentality that charting doesn't count. It's part of the job, get paid for it.
 
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I refuse to document from home. I may not be the fastest in our group (usually middle of the road), but I usually always leave on time and with 100% of my charts completed. Spending 1-2 hours after each shift charting or having to stay 1-2 hours late because you picked up those 3 extra patients in your last 1-1.5 hours that you thought would be "quick", or felt pressured to pick up because of poor staffing or inadequate physician overlap is for the birds.
 
Groove said:
I refuse to document from home. I may not be the fastest in our group (usually middle of the road), but I usually always leave on time and with 100% of my charts completed. Spending 1-2 hours after each shift charting or having to stay 1-2 hours late because you picked up those 3 extra patients in your last 1-1.5 hours that you thought would be "quick", or felt pressured to pick up because of poor staffing or inadequate physician overlap is for the birds.
Click to expand...

The last 40 minutes of my night shifts I don't see any new patients unless they are unstable. I use that time to get any outstanding charting or doctor calls completed. That way I can roll out the door at 6am. Plenty of my colleagues stay after to chart which I refuse to do. If a patient comes in after 5AM and has to wait an hour to be seen, it's not my problem as there is no physician overlap.
 
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Alvarez13 said:
Yeah, this doesn't sound right. TH went nuts on me when my partner showed up 30 minutes late and I charged them for an extra half hour of work.

As a matter of fact they recently just sent out an email stating that the only way they would pay for extra hours is if you picked up a patient in that new hour.
Click to expand...
[/QUOTE]
Sounds illegal
 
Let me be clear in my opinion. The CMGs and TH are a major contributor to stress and burnout amongst ED docs.

Lack of stability in your job, lack of due process, little support when someone criticizes you via the Ed fish bowl.

I work at an SDG. I have had my bad cases. What we do is support one another. Being a partner in a legal sense not the BS emcare, th, USACS way means I am accountable to them. I dont have to worry about someone coming into work and making 1.5x (like a locums might) or more than me while having a ****ty attitude and internally laughing at me.

Be sure that the CMGs care not for you. Their programs are BS and they have and will continue to abuse those who work for them. Sure some have better experiences but the bad ones are beyond common.

SDGs may not be the panacea but a true SDG with no admin "kings" is the best model of EM practice and will allow you to hire much better docs than any CMG could.
 
GeneralVeers said:
The last 40 minutes of my night shifts I don't see any new patients unless they are unstable. I use that time to get any outstanding charting or doctor calls completed. That way I can roll out the door at 6am. Plenty of my colleagues stay after to chart which I refuse to do. If a patient comes in after 5AM and has to wait an hour to be seen, it's not my problem as there is no physician overlap.
Click to expand...

Most EDs would not expect you to pick up new patients within the last hour of your shift, unless actively crumping. At least that's been my experience....
 
bravotwozero said:
Most EDs would not expect you to pick up new patients within the last hour of your shift, unless actively crumping. At least that's been my experience....
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I pick up until 5:30am. Our shift is from 9p-7a with new docs arriving at 6 am.
 
RustedFox said:
I work for TeamHealth at my primary job site.
I have not encountered any pushback with respect to extra hours.
When I adjust my hours, I write in the "notes" field something akin to: "Stayed late for [critical care/admission, volume surge/etc]."
We also have 1 doc that is habitually 20 mins late because "California time, brahh", so I document that I'm here late if there's no overlap.

That being said; don't abuse this privilege.
EmCare freaked out on me at my old job site simply for staying to do all my charts, and declared that "all charting must be done within the scheduled shift".
Then, door-to-doc times creeped up across the board, and they bitched about that.
Seeing as how they put us in an impossible situation, our oldest doc freaked out on them and called them out on it.
He retired from clinical practice not long after that, and became an administrator.
Click to expand...
You were staying an extra hour to chart and charging them for it?

I have a lot to learn. I'm now a year out, but commonly doing a lot of charting at home.
 
Alvarez13 said:
You were staying an extra hour to chart and charging them for it?

I have a lot to learn. I'm now a year out, but commonly doing a lot of charting at home.
Click to expand...

This is not commonplace. Most groups stipulate you have to be actively seeing new patients to bill extra hours. If you are at a 100% RVU job it will make no difference, as it will just dilute your hourly.
 
Alvarez13 said:
You were staying an extra hour to chart and charging them for it?

I have a lot to learn. I'm now a year out, but commonly doing a lot of charting at home.
Click to expand...

Here's how this happened:

HCA/EmCare was so Draconian about the door-to-doc times that they had a nurse standing over us (of course, wearing a white coat) literally watching to see when we "clicked" on new patients, and then was prodding us to move along and see that patient. I got a bit hostile when she kept interrupting my charting, asking me "why I haven't gone to see that new patient yet". So, I did exactly what she told me to do; I stopped charting and only saw new patients - leaving my charting until the hour after my shift to finish. I then billed for that hour. Several of the other docs did the exact same thing, with a rather heated e-mail response coming from our oldest doc once they said plainly "we're not paying you for that; finish it all during your shift".

Now, I simply let the door-to-doc time slide. They can huff and puff all they want. I don't work for HCA full time anymore, and their unhealthy obsession with meaningless metrics is at leat 50% of the reason why.
 
RustedFox said:
Here's how this happened:

HCA/EmCare was so Draconian about the door-to-doc times that they had a nurse standing over us (of course, wearing a white coat) literally watching to see when we "clicked" on new patients, and then was prodding us to move along and see that patient. I got a bit hostile when she kept interrupting my charting, asking me "why I haven't gone to see that new patient yet". So, I did exactly what she told me to do; I stopped charting and only saw new patients - leaving my charting until the hour after my shift to finish. I then billed for that hour. Several of the other docs did the exact same thing, with a rather heated e-mail response coming from our oldest doc once they said plainly "we're not paying you for that; finish it all during your shift".

Now, I simply let the door-to-doc time slide. They can huff and puff all they want. I don't work for HCA full time anymore, and their unhealthy obsession with meaningless metrics is at leat 50% of the reason why.
Click to expand...
Geeze. That's awful.
 
RustedFox said:
Yep. It was. I made sure to point out to "Amanda" as she was hustling me along that she was actually holding me up from seeing patients.
Click to expand...

We had a "Sepsis monitor" from corporate standing over us today. He was wearing a suit and just stood there watching. I made sure not to talk to him or even make eye contact. He was not even an MD or RN, just some corporate schmo.

Whenever these people tell me to do something, I just say "okay" and continue doing what I was doing, while going at my own pace. Usually ignoring them gets the point across.
 
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RustedFox said:
Yep. It was. I made sure to point out to "Amanda" as she was hustling me along that she was actually holding me up from seeing patients.
Click to expand...

I might have been a little crispy at 2 am while single covered at a new to me CMG FSED. I had a bolus of patients arrive, several of which were actually sick. I ran room to room, examining and ordering, within minutes of sitting down and actively reviewing results and in the middle of figuring out what to do with the ill, I got a call from an off site administrator that stated that she was following in the tracking board and felt that I wasn't clicking on some admin button regarding door to doc times or something in a fast enough manner to suit her. I ascertained that she hadn't attempted to contact anyone else (HUC, charge nurse, etc.) or even determine if she was interrupting patient care, etc. I then explained the situation before getting her full name and politely chewing her out. She got ripped a new one, the director asked the next day for me to ruffle fewer feathers and click on the buttons more often. I never went back. The CMG kept asking me to return.

Life is too short for those kinds of headaches.

Were I less crispy when this all went down, I would have just said sure and then ignored here. Done both, the latter has usually served me better, but the former felt better in the moment!
 
RustedFox said:
Here's how this happened:

HCA/EmCare was so Draconian about the door-to-doc times that they had a nurse standing over us (of course, wearing a white coat) literally watching to see when we "clicked" on new patients, and then was prodding us to move along and see that patient. I got a bit hostile when she kept interrupting my charting, asking me "why I haven't gone to see that new patient yet". So, I did exactly what she told me to do; I stopped charting and only saw new patients - leaving my charting until the hour after my shift to finish. I then billed for that hour. Several of the other docs did the exact same thing, with a rather heated e-mail response coming from our oldest doc once they said plainly "we're not paying you for that; finish it all during your shift".

Now, I simply let the door-to-doc time slide. They can huff and puff all they want. I don't work for HCA full time anymore, and their unhealthy obsession with meaningless metrics is at leat 50% of the reason why.
Click to expand...

This is all true. Same metrics at my HCA/TH shop. As you've pointed out before, HCA also enforces this braindead "duplicate MSE" count that goes up for me every time I click Sign-up for multiple pts within the same minute. The way to avoid it is to wait until the clock changes to the next minute before signing up for each pt. Our medical director coaches us on this technique.

What's the point of this metric, you ask? Well, HCA wants to ensure we aren't trying to game the system. ROFLMFAOBBQ

My understanding is the problem is not TH or Emcare, at least not directly in this context. The problem is that HCA is obsessed with meaningless metrics. I have no idea why. I could probably make HCA even more money and make their pts even happier if I didn't need to hustle to these metrics in addition to doing my real job. But, I'm sure someone in a suit has studied this and cooked all the numbers and determined that these metrics are VERY IMPORTANT for HCA's money-making ability if you squint at them correctly.

I like my job so much that I don't care a lot about that at this point, but will probably influence my choice of next job should I ever need one.
 
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hundreddaysoff said:
My understanding is the problem is not TH or Emcare, at least not directly in this context. The problem is that HCA is obsessed with meaningless metrics. I have no idea why.
Click to expand...

You really have no idea? All of the suits at HCA get bonused on these metrics. LOS, LWBS, LWOT, Press-Ganey, HCAPS all can result in significant loss of revenue for the upper level hospital admins or division admins if the targets aren't met. That's why if YOU, the busy pit doctor aren't clicking fast enough, the hospital CEO's bonus is in danger, and therefore your job is in danger. I suppose on the macro level they present these metrics at board meetings with a comparison of competitors in order to say how much they are improving. Some of it, like HCAPS are tied to federal funding for "quality measures".
 
GeneralVeers said:
You really have no idea? All of the suits at HCA get bonused on these metrics. LOS, LWBS, LWOT, Press-Ganey, HCAPS all can result in significant loss of revenue for the upper level hospital admins or division admins if the targets aren't met. That's why if YOU, the busy pit doctor aren't clicking fast enough, the hospital CEO's bonus is in danger, and therefore your job is in danger. I suppose on the macro level they present these metrics at board meetings with a comparison of competitors in order to say how much they are improving. Some of it, like HCAPS are tied to federal funding for "quality measures".
Click to expand...

Would imply to me that by using these metrics, HCA's C-suite is basically colluding with HCA's board to increase C-suite compensation. Potentially at the expense of overall HCA profits and ultimately therefore perhaps screwing over HCA's millions of non-board shareholders.

Eh, I'll buy it.
 
hundreddaysoff said:
Would imply to me that by using these metrics, HCA's C-suite is basically colluding with HCA's board to increase C-suite compensation. Potentially at the expense of overall HCA profits and ultimately therefore perhaps screwing over HCA's millions of non-board shareholders.

Eh, I'll buy it.
Click to expand...

They have to do something to justify their multi-million dollar salaries. Performance metrics are a good way to sell it to shareholders.
 
RustedFox said:
Here's how this happened:

HCA/EmCare was so Draconian about the door-to-doc times that they had a nurse standing over us (of course, wearing a white coat) literally watching to see when we "clicked" on new patients, and then was prodding us to move along and see that patient. I got a bit hostile when she kept interrupting my charting, asking me "why I haven't gone to see that new patient yet". So, I did exactly what she told me to do; I stopped charting and only saw new patients - leaving my charting until the hour after my shift to finish. I then billed for that hour. Several of the other docs did the exact same thing, with a rather heated e-mail response coming from our oldest doc once they said plainly "we're not paying you for that; finish it all during your shift".

Now, I simply let the door-to-doc time slide. They can huff and puff all they want. I don't work for HCA full time anymore, and their unhealthy obsession with meaningless metrics is at leat 50% of the reason why.
Click to expand...
I
RustedFox said:
Here's how this happened:

HCA/EmCare was so Draconian about the door-to-doc times that they had a nurse standing over us (of course, wearing a white coat) literally watching to see when we "clicked" on new patients, and then was prodding us to move along and see that patient. I got a bit hostile when she kept interrupting my charting, asking me "why I haven't gone to see that new patient yet". So, I did exactly what she told me to do; I stopped charting and only saw new patients - leaving my charting until the hour after my shift to finish. I then billed for that hour. Several of the other docs did the exact same thing, with a rather heated e-mail response coming from our oldest doc once they said plainly "we're not paying you for that; finish it all during your shift".

Now, I simply let the door-to-doc time slide. They can huff and puff all they want. I don't work for HCA full time anymore, and their unhealthy obsession with meaningless metrics is at leat 50% of the reason why.
Click to expand...

This boggles my mind having a nurse stand over you like that, that is F**cking Bonkers
 
EM is not the only specialty this is happening to. I hear it from Hospitalist, Gas, rads...... Its the owning of medicine and when they write the checks, you lose control.

I am most happy at my locums job. I don't see a new pt 60-90 min before my shift ends. I don't pick anything complicated within 2 hrs b/c it take atleast 3+ if I am lucky.

I get paid by the hour, I work hard when I am there but I also have an exit plan where I am leaving right when the clock tolls.


I would never go back to a CMG or even SDG (unless its a unicorn). The meetings, metrics, protocols, etc has created a bunch of minions. I could bear it if it doesn't get worse. But every year, it gets worse.

But atleast when I do locums, I don't have to pay any mind to any of these metrics.
 
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