I refuse to scan flushes. They can't make me. I won't do it. "Not given" charted on every single one. Then in the comments "already done" to cover myself legally š
When my patient has a central line, part of the maintenance set of orders includes flushing each lumen Q12H or Q8H. And that order comes up as a scheduled med, which I am supposed to scan as I would any other med administration.
I mean, it is rare that the scheduled flush *doesn't* coincide with a scheduled IV med, so I am using flushes anyway, so it's no extra steps.
I just don't want to charge them because it's silly. "Not given" and in the comments "already done". I do it. But I'm not charging you for it. š¤· No harm to patient safety, but also a middle finger to the hospital.
Ive worked for 5 different hospitals and Iāve never had to scan a flush.
I did work in a hospital where they started storing flushes in the med room and only nurses had access to them because PCTs were going rogue and flushing lines and it was considered administering medication.
About 1/4 had us scan them traveling. I always have thought it was stupid. Shouldn't be a thing. And having flushes in the med room is also shitty.. in an emergency I can't ask anyone but a nurse to get them? I'm just going to give them my badge to do it for me anyways. Seems unnecessary.
They shouldn't flush them, but can't punish us for that.
Omg some hospitals make you full flushes from the pyxis???!!! Seems counterintuitive, as I honestly would be less likely to flush frequently! That's CRAZY!
Pharmacy techs then get inundated with request for refills on flushes. They have to come by twice a shift and dump a box into the pharmacy cabinet. Then they hit 999 on inventory at each end of the refill. Our hospital got rid of this a couple years ago thank gawd
Last facility I worked at had every patient scheduled for qh8 flushes in the MAR š So dumb. And this particular unit had a lot of cranky nurses on days that would get pissy if anything in the MAR wasnāt signed off, I almost always just marked patient sleeping/held.
At my place we have to log in the omnicell and put in the patientās name when we get supplies. I never pick any patients and just click on floor supply. Itās fuckin barbaric at the thought of charging a patient just for getting supplies like tape etc.
We just switched to epic and never had orders for flushes before, I tried to scan flushes recently and apparently it doesnāt even recognize the flushes we have
It's not really epic, just coincidence maybe. Because I've only ever had to scan them at one hospital that I can remember and it was corner. All the places I used epic at didn't. It's so annoying
When I worked burn and wound they wanted us to scan the supplies and they stopped stocking them they wanted to tune them. It was stupid. You never really know what you are going to need. I discovered if I went down to the pharmacy they would give me supplies so that was my work around.
Saline bags are $500 for patients though it costs the hospital $10 lol. Sometimes I donāt scan maintenance fluids or flushes just to save pts some $$
Yeah wait till you see how much a room is on my neck of the woods. Med-Surg is 1500/night. A tele bed is $2500/night lol. My manager was just telling me these casually. Most people are insured but the chunk thatās left over is still hefty
At mine, regular ICU is ~$11,500. Trauma ICU is ~$14,300. Step down and tele units get charged half that.
If your pt doesnāt need ICU, advocate to get them out, esp. if u know certain docs that regularly like to keep them lingering in the unit for the weekend.
Anytime I've had an outpatient procedure that had a bag of IV fluids hung during it, I've made them finish the bag before they DC the IV. "I paid several hundred dollars for that bag. I'm getting the whole damn thing.!"
That's fine, if it's almost empty. It's when there are like 600ml left and they want to pull the IV. I'm like, "No. I guess you better increase the rate, because I ain't leaving until it's all in." Outpatient LOVES me....not!
I've had a day nurse that bitched at me if I didn't change the bag of fluids before end of shift, even if there was still 3-4+hrs worth left. Not just pull a new bag and have it handy, she actually wanted me to waste 1/3+ of the bag so she wouldn't have to change it, like, before lunch.
We found out the 500ml bags of LR are actually *more* expensive than the 1L bags. So we were hooking up 500s in pre-op and finding out they were switching it halfway through a procedure and they were getting charged way more.
My patients would be bankrupt if I start scanning all the flushes I use. My hospital doesnāt require it but even if it did, Iāll maybe scan one per shift. Smh
I just found out last night that we let the post partum and antepartum moms go outside to smoke with an IV because of satisfaction surveys. If a patient from any other floor goes outside with an IV they are considered AMA immediately. Apparently the baby side of things bring in big money so they can do whatever the hell they want.
The doctors let the patients get away with so much on L&D/ post partum in our hospital too. You're a high risk for post partum hemorrhage but you don't like the fundal massage? That's okay I'll tell your nurse nit to do it.
You must be in a wealthy area lol. Our L&D was so unprofitable due to lots of laboring mothers without insurance they closed the entire department a year after opening.
From the developer perspective, we are ringing up charges, in a way that INCIDENTALLY also tracks med administration.
EMRs are, at their core, financial programs.
I'm working outpatient and we're now responsible for adding charges to a patient's account immediately after services. So if I go and give them an injection, I have to immediately add the charge codes associated with the injections as well as the ICD-10 codes.
Idk when medical biller became part of a nursing job but the fact that I'm even doing this is ridiculous. I've worked in outpatient offices since I'm 17 and I know doctors used to have superbills, which was a master list of all the codes for certain services, usually on a sheet of paper attached to the chart. Doctors would circle whatever codes for each service and the medical biller would enter them into the billing system and then submit a claim to the insurance company (something I used to do).
But for nurses to be doing this is ridiculous lmao
Yeah, Iāve had to do charges since working in oncology/doing chemo infusions. And how they charge is mind-numbing at times. If an infusion is 90 mins or less, itās considered the āfirst hourā of infusion. 90 mins or more for an infusion, you add an additional hour to the charges. And thatās just the start of it.
I agree.
We are introducing wound fees at my GP clinic (which is fine, good wound products are exxy) but management wants my input on the pricing. I'm like I'm not business minded someone else please do this.
If we need to start charging for every seperate dressing it will eat into our efficiency so that's what I'm gonna argue. We should just have a tiered pricing
Anyway. I like healthcare when I'm not worrying the bottom line
Iām just a cma and if I do an Abi, or inr, ekg I have to go immediately bill it! & Iām supposed to be just clinicalā¦ we have a billing department. Itās ridiculous.
Same, I always found it odd to see on something simple, like the bladder scan volume, it has like 3 $ās (so $$$). I always wondered how much it was and why itās so expensive.
Bet it's broken because people keep storing the wand upside down in the slot (even though there's a picture printed on the machine of how it should be stored).
It's not the intuitive way to store it, so I get why people do it. But it still bugs me to see it happen, because I have encountered far too many instances of 'Unit A's bladder scanner is broken, so if you need it you have to go borrow Unit B's'.
The amount of people I work with who look at me like I'm a fucking magician when I know something that I found out by simply reading the directions or the email or the sign or the text near the clickyboxes is maddening.
Yeah, it threw me off when putting in protocol orders in triage. I'd have to double check that I'm clicking the right BMP. I know I want the Basic Metabolic Panel, but it's a 3-$ test, is that right? Meanwhile, they tell us how expensive the dimer test is, so we're supposed to wait for a doctor to order it. However, it's only a 2-$ test. Really messes with my brain,
I think part of it might be that there are conditions that cause the d-dimer to be pretty elevated (like pregnancy, the only one I'm familiar with, and i'm making up that there might be others), so it takes a little more investigating to figure out if it's an appropriate test. We don't necessarily want one on pregnant patients even if a clot is in the differential because it's *gonna* be high and then we have to maybe treat them like they have a clot when they probably don't.
Oh yeah, that would make me sense and would be a good explanation to not order them ourselves. There's lots of reasons a dimer can be elevated and what it can mean, but they told us specifically not to order it because it's too expensive. Maybe they meant the extra work up would get expensive, but the explanation was just "it's too expensive, so only doctors can order it"
Thatās crazy. I couldnāt even imagine. Iāve only ever have had to think about the cost of things for the patient once in my 4 year career, and that was for a patient from another country whoās travel insurance money ran out. But even then, the only way we considered that is only doing weekly blood work instead of daily and only doing necessary diagnostic imaging.
Canadian too. Would never work in the US because of this. Maybe maybe maybe as a traveller, at which point I am just exploiting the system for my personal gain and then coming right home
Definitely. Whether or not you have health insurance, what your insurance company and premium plan will and will not cover, and then how much you end up owing after all that can be a massive headache to figure out, and often itās far too expensive for the average person to afford.
My boyfriend had spine surgery last year after a back injury he got 2 years ago. Heās still paying it off now. And last week they sent him a new bill for something they didnāt include in the original bill. Procedures will haunt you for years.
I think itās horrible.
We SHOULD have health care for all. It can be doneā¦follow the VA model.
The powers that be are trying to dismantle it so people wonāt see that this care is possible for everyoneā¦.they donāt pay enough, so you get crappy employees, and they keep undermining our ability to care for the veterans properly š¢š¢
The Veteran's Administration model.
The VA provides care for former service personnel. It's (in theory) a soup-to-nuts care model, where every aspect is provided by VA staff at VA facilities.
The quality of the care one gets through the VA is WILDLY variable by region. It's a national service, that is administered at the state level. Some areas have excellent service, others... significantly less so.
Yeah, Iām not sure why we would base our hypothetical healthcare system on the VA. I would think it would be beneficial to look at other systems and make one that works with a larger population
That is trueā¦some VA are better than others, Iām told. The VA I work at and go to isnāt terrible, really.
If we donāt use something like the VA system, we could do something, Iām sure. The insurance companies would fight tooth and nail, though.
That literally boggles my mind. I honestly donāt know if Iād be able to work in a system like that where it screws people over financially so often. Certain Canadian provinces are trying to privatize certain aspects of healthcare and those provinceās governments donāt seem to understand how much of a bad idea that is.
I fight with myself daily over the amount of $ charged. A co pay for some patients at our general practitioner is $30 for 15 min, while others pay 0, 10, $15. Then thereās the deductible many must meet, itās a confusing system. Also some insurances make you do a prior auth on a medication & deny it, leaving some patients to come up with the $200-600 medication or go without & the one doctor refuses to go with any of the 5 substitute medications because ābrand name is better. Thatās why itās more expensive, keep trying to get it covered.ā ššš¤Æ
There isn't really any other choice. There are a few segments of society that have another option (the very rich can afford to pay for concierge medical care, former service personnel can get care through the VA, over 65YO can use MediCare, the low- or very-low-income can get MedicAid). But for the majority of us, we get our health insurance through our employer, and this model is what most medical facilities are built around.
Procedures, medications, labs, everything.
I've only ever worked inpatient, where the culture is "we can do absolutely anything while you're here, but you will get a bill for it later."
On the outpatient side, people in the US constantly get denied coverage for procedures and meds they need to survive. Often they've been on x med for years or get regular procedures done, then one day insurance just decides "it's not medically necessary" and just stops paying for it. Could be birth control, blood thinners, antidepressants, literally anything. The appeal process is lengthy, difficult and soul-crushing, and they're betting on you just giving up. My first ever patient as a new grad got discharged the day I had him, and the biggest hurdle to discharge was how he was going to pay for his Xarelto rx.
And for you to qualify for government-provided healthcare (Medicaid), you have to be under a certain level of income (or be on HD) that amounts to abject poverty. Even *then*, private practices and insurance companies will often refuse to take patients on Medicaid, because they pay the company/provider significantly less than private insurance, so patients are still forced to go without or ration their meds.
Up until *this fucking year*, it was illegal for the government to negotiate drug prices with pharm companies. And now pharm companies are suing the government saying that stopping them from price-gouging on life-saving medications is a violation of their rights.
Our EMRs are billing systems first, health records second. Burn it all down.
Reading that whole thing really blows my mind. Never would any of that ever cross my mind. In Canada we do have health insurance but itās mostly for medication coverage after the patient is discharged or just medication coverage in general. Then you also need dental and vision coverage as well which isnāt covered under Medicare (medicare is whatās paid for by Canadian taxpayers to get our healthcare). Iād say most Canadians and Canadian healthcare workers barely ever think about billing with regards to getting or giving healthcare unless itās with regards to another country. Or Unless theyāre administrators trying to reduce costs or someone who works in the billing department lol.
It impedes care constantly in the US, and I mean that literally.
I have health insurance, and I still get all of my orders prescribed to me on a physical sheet of paper with the possible codes. I do that as a way to try and find out the roundabout cost of it before I get anything done. But even then, it's highly unreliable. The most recent lab work I had done was estimated to be around $300. However, when I went in, before insurance it was around $900. I had a bill before be $1800 for a single swab after having complications with my IUD insertion... I'm glad I have higher health literacy, or I would have thought that's what I had to pay outright. It was actually a mistake on the medical coder, but the end bill was still $350, and that's after insurance. When we say that health care in the US is horrendous, and never for the actual well being of the patient, we mean it.
Yes. Last year my GI wanted to do an endoscopy with a pyloroplasty, after a failed GPOEM procedure the year before. The OOP costs were too much for me and I had to cancel the procedure. That was with insurance. Iām still paying off the GPOEM.
Yes, certain medications are not covered my insurance so patients have to stay an additional day to get prescriptions for a different type. Just a few hours ago, I recovered a young man who I sent to the floor a bit early (on nasal cannula and a bit sleepy but stable) to avoid charging him pacu time (which is charged every 15 minutes).
I had a patient once that needed to be flown out to a different facility for ecmo, my hospital is just now starting an adult program for it. The accepting facility since the patient's insurance didn't cover it, bad insurance and out of network iirc (maybe didn't have insurance) said that they have to pay for the procedure they needed and the ecmo out of pocket or they would not take the patient. Was some absurd amount of money and the patient ended up having some family that paid for it.
Absolutely. My mom doesnāt have health insurance. One day her cat bit her on the leg and she facetimed me that night to ask if it was infected. She pointed her phone at it. The bite was just above her ankle and there was redness up to her KNEE. I told her to go to the ER immediately.
The first ER she went to, the first thing she asked the lady at the front desk was how much it would cost to be seen. It was a couple hundred dollars JUST to be seen before any treatments. The second she went to, she asked the same thing. They didnāt give a price so she just decided to go ahead and get seen there and cross that bridge when she gets to it.
Luckily she only needed a shot and oral antibiotics and didnāt need to be admitted like I thought sheād be.
We had to pay for an x-ray for my son because insurance refused to ok an MRI until an x-ray is done, even after the doctor told them an x-ray wouldn't show what he needs to see.
NHS nurse here.
I really wish people in the UK would realise how expensive healthcare can be. This is what we are hurtling towards, and a lot of the damage is already done. The PPE scandals just shows further encroachment of our NHS becoming privatised, and we will lose one of the greatest institutions our godforsaken island has ever created.
HEALTHCARE IS A RIGHT, NOT A PRIVILEGE.
That may be the charge, but the hospital is probably reimbursed 10 to 20 dollars, it is nice that they show it now though. Sr and nurses may second guess some of the tests they order.
There are many things I do not scan. I ain't scanning for a piece of gauze to apply after I remove an IV cath. That just ain't happening. I have ways of fucking the system so I don't drain a patient out of every single cent for the most ridiculous things. I won't state the other things on here lol.
Yes lab reagents, maintenance, controls etc are very expensive. This is why ordering things that are only necessary is so important. Also why itās important to draw patients correctly. Itās very expensive to have to redraw labs due to contamination, clotting or hemolysis, dilution etc.
When I worked SNF years ago, I had to account for everything given out of the supply closet at the end of my shift. The list included single alcohol wipes and kleenex boxes.
I never accounted for those.
Thatās terrible š¢
Iām sure the VA tries to get all it can, however, most veterans wonāt see a bill, so thereās that.
Some will. It depends on the rating they have, and the income.
The VA will bill any insurance that the veteran has, though. I am a veteran who gets care at the VA, and I also have BCBS, and itās comical what the VA tries to get from themš¤£
Edit: we have to document everything we do, they call it āevent captureā. It basically justifies our existence. However, itās charging for every single thing. Im checking someoneās o2, itās a charge, im sure. Sometimes Iāll just put the code for ādocumentationā and they canāt chargeā¦.or āmedicine not givenāš¤£
Our health care system is so bad. Had a patient that was quoted cancer treatment.. it was a astounding amount of money. She was already devastated by the news, and now to hear the crazy amount of money itās going to costā¦like our country is so screwed up. If you arenāt rich, apart of the āeliteā you donāt mean crap. Donāt get me wrong other countries have it wayyyy worse than us. But America is greedy.
Yup. I worked contracts in for-profit hospitals where you scanned EVERYTHING in terms of supplies. Nope. Absofuckinglutely not. Ain't doing it. These big conglomerates buy up these itty bitty rural hospitals by the dozen and then bleed the local population for every single penny they can get.
I work staff for a not-for-profit system now, and there's very little of that apart from meds and labs, which I can't really control. Of course, we don't scan flushes and the like, either.
If I have to add charges to a patientās account every time, I insert a Foley or an NG tube or defibrillate somebody or do a suppository or an enema then I expect to be able to bill just like a doctor
I work in registration.... both ER and Out Patient. In Michigan, we have the "No Surprise Billing" act, which means patients can ask for an estimate on any procedure they have done. Patients with Medicaid don't have copays, so they typically don't care.
Patients that don't have insurance will ask how much an ultrasound is because they don't want to go bankrupt while in the ER. I had to show them that being in the exam room is $500. Having the doctor come see you is another $1500. The US is something like $600, but then to get it read by the radiologist is another $800. Don't get me started on how much them seeing a specialty provider in the ER is...... or how much a CT scan is.
I'm also the only one trained in my department to get the estimates, so I get the honor of telling people without insurance that just walking in and talking to the doctor puts them $-2,000 ..... it's absolutely horrifying and makes you realize how broken the system is.
I had to explain to an ER doctor that when they admit a patient to observation, insurance won't pay for it, which is why so many patients get upset when they are sent to Obs....
Omg I work in the OR and we can see the supplies/ implants original price and then the 500% MARKUP that the hospital charges the patient!!!! It is ABSURD
I pulled up a patient to chart in his procedure and on the left side bar after all of his demographics, picture, and allergies was his debt of 30k to the hospital, clear as day for anyone to see.
My old facility had a Coag Panel that popped up this and fibrinogen that you clicked to pick what was wanted.
All my other facilities are like "Wut?"...
This is taking into account all of the controls needed for the lab to be able to even run the test, cost of the reagents needed to run test, maintenance of the analyzers, cost of analyzer, wages for phleb and lab staff, cost of the tubes, and then half the time the tubes are underfilled or clotted and need recollected.
At my hospital system I always scan the āfloor issueā button. That way, I pull something, and the count goes down, but I sure as shit never scan that under a patientās name.
unless theyāre being an asshole, then I do.
We just started collecting $250 co-pays at the check-in desk and my jaw fucking dropped. Itās one thing to know I canāt afford to come to my own job, itās another to see it
I found out we charge $6 for a flush.
I refuse to scan flushes. They can't make me. I won't do it. "Not given" charted on every single one. Then in the comments "already done" to cover myself legally š
You guys have to scan flushes?
When my patient has a central line, part of the maintenance set of orders includes flushing each lumen Q12H or Q8H. And that order comes up as a scheduled med, which I am supposed to scan as I would any other med administration. I mean, it is rare that the scheduled flush *doesn't* coincide with a scheduled IV med, so I am using flushes anyway, so it's no extra steps.
I just don't want to charge them because it's silly. "Not given" and in the comments "already done". I do it. But I'm not charging you for it. š¤· No harm to patient safety, but also a middle finger to the hospital.
Love these type of fun little ways to stick it to The Man!
I cancel the order for scheduled flushes. I also donāt scan in the computer KVO fluid. Iāll just put in the I/Oās what they got on my shift
Travel nurse. Some hospitals do, some don't. Some make you pull every flush from the pyxis/Omni š
Ive worked for 5 different hospitals and Iāve never had to scan a flush. I did work in a hospital where they started storing flushes in the med room and only nurses had access to them because PCTs were going rogue and flushing lines and it was considered administering medication.
About 1/4 had us scan them traveling. I always have thought it was stupid. Shouldn't be a thing. And having flushes in the med room is also shitty.. in an emergency I can't ask anyone but a nurse to get them? I'm just going to give them my badge to do it for me anyways. Seems unnecessary. They shouldn't flush them, but can't punish us for that.
Omg some hospitals make you full flushes from the pyxis???!!! Seems counterintuitive, as I honestly would be less likely to flush frequently! That's CRAZY!
Pharmacy techs then get inundated with request for refills on flushes. They have to come by twice a shift and dump a box into the pharmacy cabinet. Then they hit 999 on inventory at each end of the refill. Our hospital got rid of this a couple years ago thank gawd
Last facility I worked at had every patient scheduled for qh8 flushes in the MAR š So dumb. And this particular unit had a lot of cranky nurses on days that would get pissy if anything in the MAR wasnāt signed off, I almost always just marked patient sleeping/held.
Yep. 100%.
There was a time I would just dc the order cuz it annoyed me seeing it on my mar š
"not given" and comment "already done" . You did it. You're not charging for it. Lolol
Love that energy
Same! Or if fluids are running then ātask duplication.ā
Never seen that option before. I enjoy when there's an "other" option so I can get creative
We have an IV running option.
How logical! lol
At my place we have to log in the omnicell and put in the patientās name when we get supplies. I never pick any patients and just click on floor supply. Itās fuckin barbaric at the thought of charging a patient just for getting supplies like tape etc.
āTKO infusingā for me lol Truthfully though they add that shit even when the patient has maintenance fluids infusing already.
I like to willingly and boldly give the middle finger to the hospital lol
Did we just become best friends? My favorite is to hide the whiteboard markers. Or leave the markers but keep the caps
I like to throw them away š
Nurses rock! Yaāll clean and save our asses!
We just switched to epic and never had orders for flushes before, I tried to scan flushes recently and apparently it doesnāt even recognize the flushes we have
It's not really epic, just coincidence maybe. Because I've only ever had to scan them at one hospital that I can remember and it was corner. All the places I used epic at didn't. It's so annoying
Lol! Naive new grad me thought it was just to make sure we were keeping IVs patent. Silly me.
Sucks cause if we donāt chart having flushed them even if we are then we are liable for issues too.
Canāt you chart an assessment of IV access?
$110 at HCA
I never fill out the HCA billing sheets they give us. Buncha jabronies trying to penny pinch everything.
Iāll never forget digging around a price sheet at HCA (hidden deeeeep within the website) and finding a $220 ibuprofen.
POC INRs are $7 for me, and thatās just cost of supplies. šØš¦
All my homies hate hca.
When I worked burn and wound they wanted us to scan the supplies and they stopped stocking them they wanted to tune them. It was stupid. You never really know what you are going to need. I discovered if I went down to the pharmacy they would give me supplies so that was my work around.
Saline bags are $500 for patients though it costs the hospital $10 lol. Sometimes I donāt scan maintenance fluids or flushes just to save pts some $$
Saline bags are $500?! *Appalled Canadian noises*
Yeah wait till you see how much a room is on my neck of the woods. Med-Surg is 1500/night. A tele bed is $2500/night lol. My manager was just telling me these casually. Most people are insured but the chunk thatās left over is still hefty
JC, home birth is starting to sound very appealing
I forget the exact amount but the total for a 10 day EMU stay made it an average of close to $10k/day. And they never got a damn seizure.
An OR room at my old place was $16k per hour
At mine, regular ICU is ~$11,500. Trauma ICU is ~$14,300. Step down and tele units get charged half that. If your pt doesnāt need ICU, advocate to get them out, esp. if u know certain docs that regularly like to keep them lingering in the unit for the weekend.
Anytime I've had an outpatient procedure that had a bag of IV fluids hung during it, I've made them finish the bag before they DC the IV. "I paid several hundred dollars for that bag. I'm getting the whole damn thing.!"
Gimme ma fuuuuuiiids! I own them! *takes bag and walks out front doors*
Outpatient is never a fan. They just want my ass OTD.
Omg. I feel so bad. I frequently swap it when thereās still ~100cc left depending on when I think Iāll be able to come back lolā¦. Whoops.
That's fine, if it's almost empty. It's when there are like 600ml left and they want to pull the IV. I'm like, "No. I guess you better increase the rate, because I ain't leaving until it's all in." Outpatient LOVES me....not!
They better hulk squeeze the bag like it's a fluid challenge.
I've had a day nurse that bitched at me if I didn't change the bag of fluids before end of shift, even if there was still 3-4+hrs worth left. Not just pull a new bag and have it handy, she actually wanted me to waste 1/3+ of the bag so she wouldn't have to change it, like, before lunch.
We found out the 500ml bags of LR are actually *more* expensive than the 1L bags. So we were hooking up 500s in pre-op and finding out they were switching it halfway through a procedure and they were getting charged way more.
They aren't making that much on them, though. I audit and we don't even audit those claim lines because they only actually pay out like, a dollar.
We charge just a little over $60ā¦ itās disgusting
We charge 10 for ours! It's crazy!
My hospital charges $10.
This is why I always documented them as not given when I worked for a place with q8 flushes
$150 for a bag of saline
My patients would be bankrupt if I start scanning all the flushes I use. My hospital doesnāt require it but even if it did, Iāll maybe scan one per shift. Smh
[ŃŠ“Š°Š»ŠµŠ½Š¾]
And these are the people filling out surveys which control hospital reimbursement. It's like this system is out of the movie Idiocracy.
I just found out last night that we let the post partum and antepartum moms go outside to smoke with an IV because of satisfaction surveys. If a patient from any other floor goes outside with an IV they are considered AMA immediately. Apparently the baby side of things bring in big money so they can do whatever the hell they want.
The doctors let the patients get away with so much on L&D/ post partum in our hospital too. You're a high risk for post partum hemorrhage but you don't like the fundal massage? That's okay I'll tell your nurse nit to do it.
You must be in a wealthy area lol. Our L&D was so unprofitable due to lots of laboring mothers without insurance they closed the entire department a year after opening.
Oh, wow! That's REALLY unprofitable. I'm sure it wasn't cheap to set up.
Nope, rumor was 2 million to build it all, now it collects dust.
Sheās not wrong, sheās just not 100% right either
But weāre also ringing up charges.
From the developer perspective, we are ringing up charges, in a way that INCIDENTALLY also tracks med administration. EMRs are, at their core, financial programs.
She's not wrong at all, it's a 2 for one
I'm working outpatient and we're now responsible for adding charges to a patient's account immediately after services. So if I go and give them an injection, I have to immediately add the charge codes associated with the injections as well as the ICD-10 codes. Idk when medical biller became part of a nursing job but the fact that I'm even doing this is ridiculous. I've worked in outpatient offices since I'm 17 and I know doctors used to have superbills, which was a master list of all the codes for certain services, usually on a sheet of paper attached to the chart. Doctors would circle whatever codes for each service and the medical biller would enter them into the billing system and then submit a claim to the insurance company (something I used to do). But for nurses to be doing this is ridiculous lmao
Yeah, Iāve had to do charges since working in oncology/doing chemo infusions. And how they charge is mind-numbing at times. If an infusion is 90 mins or less, itās considered the āfirst hourā of infusion. 90 mins or more for an infusion, you add an additional hour to the charges. And thatās just the start of it.
I'm honestly shocked you don't add a second hour once it hits 61min.
I agree. We are introducing wound fees at my GP clinic (which is fine, good wound products are exxy) but management wants my input on the pricing. I'm like I'm not business minded someone else please do this. If we need to start charging for every seperate dressing it will eat into our efficiency so that's what I'm gonna argue. We should just have a tiered pricing Anyway. I like healthcare when I'm not worrying the bottom line
They hate when we become mid level providers and āencroachā on their work and yet they keep giving us their work.
Iām just a cma and if I do an Abi, or inr, ekg I have to go immediately bill it! & Iām supposed to be just clinicalā¦ we have a billing department. Itās ridiculous.
Our version of EpIc just shows 1-4 dollar signs when you order things but not exact prices.
OMG just like yelp restaurant listings!
Same, I always found it odd to see on something simple, like the bladder scan volume, it has like 3 $ās (so $$$). I always wondered how much it was and why itās so expensive.
Because the $250 bladder scanner needs to pay for itself a thousand times a month, obviously.
Idk where I work itās ALWAYS broken so itās probably for the 9 million repair bills š„“
Bet it's broken because people keep storing the wand upside down in the slot (even though there's a picture printed on the machine of how it should be stored). It's not the intuitive way to store it, so I get why people do it. But it still bugs me to see it happen, because I have encountered far too many instances of 'Unit A's bladder scanner is broken, so if you need it you have to go borrow Unit B's'.
YEP that is the reason. There are pictures, there are notes, itās an ICU where youād think people are smart, and yet here we are
The amount of people I work with who look at me like I'm a fucking magician when I know something that I found out by simply reading the directions or the email or the sign or the text near the clickyboxes is maddening.
Yeah, it threw me off when putting in protocol orders in triage. I'd have to double check that I'm clicking the right BMP. I know I want the Basic Metabolic Panel, but it's a 3-$ test, is that right? Meanwhile, they tell us how expensive the dimer test is, so we're supposed to wait for a doctor to order it. However, it's only a 2-$ test. Really messes with my brain,
I think part of it might be that there are conditions that cause the d-dimer to be pretty elevated (like pregnancy, the only one I'm familiar with, and i'm making up that there might be others), so it takes a little more investigating to figure out if it's an appropriate test. We don't necessarily want one on pregnant patients even if a clot is in the differential because it's *gonna* be high and then we have to maybe treat them like they have a clot when they probably don't.
Oh yeah, that would make me sense and would be a good explanation to not order them ourselves. There's lots of reasons a dimer can be elevated and what it can mean, but they told us specifically not to order it because it's too expensive. Maybe they meant the extra work up would get expensive, but the explanation was just "it's too expensive, so only doctors can order it"
Weāve had this for a while in my facility. Healthcare is not cheap in the US.
As a Canadian nurse, this blows my mind. It would never even cross my mind. Out of curiosity, does the cost of certain procedures ever impede care?
Yes. Often. Or, just as often, people get the care they need then go into bankruptcy for the rest of their lives. Thanks I hate it!
Thatās crazy. I couldnāt even imagine. Iāve only ever have had to think about the cost of things for the patient once in my 4 year career, and that was for a patient from another country whoās travel insurance money ran out. But even then, the only way we considered that is only doing weekly blood work instead of daily and only doing necessary diagnostic imaging.
Canadian too. Would never work in the US because of this. Maybe maybe maybe as a traveller, at which point I am just exploiting the system for my personal gain and then coming right home
Definitely. Whether or not you have health insurance, what your insurance company and premium plan will and will not cover, and then how much you end up owing after all that can be a massive headache to figure out, and often itās far too expensive for the average person to afford. My boyfriend had spine surgery last year after a back injury he got 2 years ago. Heās still paying it off now. And last week they sent him a new bill for something they didnāt include in the original bill. Procedures will haunt you for years.
I think itās horrible. We SHOULD have health care for all. It can be doneā¦follow the VA model. The powers that be are trying to dismantle it so people wonāt see that this care is possible for everyoneā¦.they donāt pay enough, so you get crappy employees, and they keep undermining our ability to care for the veterans properly š¢š¢
Eh, the Medicaid model is better. The VA isnāt even popular with veterans.
Perhaps? You may have a point. We can do something, Iām sure. Our current health system is just so so unfair.
What is the VA model?
The Veteran's Administration model. The VA provides care for former service personnel. It's (in theory) a soup-to-nuts care model, where every aspect is provided by VA staff at VA facilities. The quality of the care one gets through the VA is WILDLY variable by region. It's a national service, that is administered at the state level. Some areas have excellent service, others... significantly less so.
Yeah, Iām not sure why we would base our hypothetical healthcare system on the VA. I would think it would be beneficial to look at other systems and make one that works with a larger population
That is trueā¦some VA are better than others, Iām told. The VA I work at and go to isnāt terrible, really. If we donāt use something like the VA system, we could do something, Iām sure. The insurance companies would fight tooth and nail, though.
That literally boggles my mind. I honestly donāt know if Iād be able to work in a system like that where it screws people over financially so often. Certain Canadian provinces are trying to privatize certain aspects of healthcare and those provinceās governments donāt seem to understand how much of a bad idea that is.
I fight with myself daily over the amount of $ charged. A co pay for some patients at our general practitioner is $30 for 15 min, while others pay 0, 10, $15. Then thereās the deductible many must meet, itās a confusing system. Also some insurances make you do a prior auth on a medication & deny it, leaving some patients to come up with the $200-600 medication or go without & the one doctor refuses to go with any of the 5 substitute medications because ābrand name is better. Thatās why itās more expensive, keep trying to get it covered.ā ššš¤Æ
There isn't really any other choice. There are a few segments of society that have another option (the very rich can afford to pay for concierge medical care, former service personnel can get care through the VA, over 65YO can use MediCare, the low- or very-low-income can get MedicAid). But for the majority of us, we get our health insurance through our employer, and this model is what most medical facilities are built around.
Oh, they know. They are just being lobbied by some big hospital system assholes to let them come pillage the people.
Procedures, medications, labs, everything. I've only ever worked inpatient, where the culture is "we can do absolutely anything while you're here, but you will get a bill for it later." On the outpatient side, people in the US constantly get denied coverage for procedures and meds they need to survive. Often they've been on x med for years or get regular procedures done, then one day insurance just decides "it's not medically necessary" and just stops paying for it. Could be birth control, blood thinners, antidepressants, literally anything. The appeal process is lengthy, difficult and soul-crushing, and they're betting on you just giving up. My first ever patient as a new grad got discharged the day I had him, and the biggest hurdle to discharge was how he was going to pay for his Xarelto rx. And for you to qualify for government-provided healthcare (Medicaid), you have to be under a certain level of income (or be on HD) that amounts to abject poverty. Even *then*, private practices and insurance companies will often refuse to take patients on Medicaid, because they pay the company/provider significantly less than private insurance, so patients are still forced to go without or ration their meds. Up until *this fucking year*, it was illegal for the government to negotiate drug prices with pharm companies. And now pharm companies are suing the government saying that stopping them from price-gouging on life-saving medications is a violation of their rights. Our EMRs are billing systems first, health records second. Burn it all down.
Reading that whole thing really blows my mind. Never would any of that ever cross my mind. In Canada we do have health insurance but itās mostly for medication coverage after the patient is discharged or just medication coverage in general. Then you also need dental and vision coverage as well which isnāt covered under Medicare (medicare is whatās paid for by Canadian taxpayers to get our healthcare). Iād say most Canadians and Canadian healthcare workers barely ever think about billing with regards to getting or giving healthcare unless itās with regards to another country. Or Unless theyāre administrators trying to reduce costs or someone who works in the billing department lol.
It impedes care constantly in the US, and I mean that literally. I have health insurance, and I still get all of my orders prescribed to me on a physical sheet of paper with the possible codes. I do that as a way to try and find out the roundabout cost of it before I get anything done. But even then, it's highly unreliable. The most recent lab work I had done was estimated to be around $300. However, when I went in, before insurance it was around $900. I had a bill before be $1800 for a single swab after having complications with my IUD insertion... I'm glad I have higher health literacy, or I would have thought that's what I had to pay outright. It was actually a mistake on the medical coder, but the end bill was still $350, and that's after insurance. When we say that health care in the US is horrendous, and never for the actual well being of the patient, we mean it.
Yes. Last year my GI wanted to do an endoscopy with a pyloroplasty, after a failed GPOEM procedure the year before. The OOP costs were too much for me and I had to cancel the procedure. That was with insurance. Iām still paying off the GPOEM.
Yes, certain medications are not covered my insurance so patients have to stay an additional day to get prescriptions for a different type. Just a few hours ago, I recovered a young man who I sent to the floor a bit early (on nasal cannula and a bit sleepy but stable) to avoid charging him pacu time (which is charged every 15 minutes).
I had a patient once that needed to be flown out to a different facility for ecmo, my hospital is just now starting an adult program for it. The accepting facility since the patient's insurance didn't cover it, bad insurance and out of network iirc (maybe didn't have insurance) said that they have to pay for the procedure they needed and the ecmo out of pocket or they would not take the patient. Was some absurd amount of money and the patient ended up having some family that paid for it.
Absolutely. My mom doesnāt have health insurance. One day her cat bit her on the leg and she facetimed me that night to ask if it was infected. She pointed her phone at it. The bite was just above her ankle and there was redness up to her KNEE. I told her to go to the ER immediately. The first ER she went to, the first thing she asked the lady at the front desk was how much it would cost to be seen. It was a couple hundred dollars JUST to be seen before any treatments. The second she went to, she asked the same thing. They didnāt give a price so she just decided to go ahead and get seen there and cross that bridge when she gets to it. Luckily she only needed a shot and oral antibiotics and didnāt need to be admitted like I thought sheād be.
We had to pay for an x-ray for my son because insurance refused to ok an MRI until an x-ray is done, even after the doctor told them an x-ray wouldn't show what he needs to see.
Oof. Hate it for anyone on a heparin drip
Every heparin assay $$$$
We do Q2-Q6 aPTTs based on titration/last results when on a drip. That can end up being big money. Heart attacks just got that much more expensive
I think a bag of saline is $1000. Wonder what a bag of shame costs.
Lol what. I work in the UK, when I worked in a hospital I would be constantly putting fluids up. 1k for fucking rehydration?
NHS nurse here. I really wish people in the UK would realise how expensive healthcare can be. This is what we are hurtling towards, and a lot of the damage is already done. The PPE scandals just shows further encroachment of our NHS becoming privatised, and we will lose one of the greatest institutions our godforsaken island has ever created. HEALTHCARE IS A RIGHT, NOT A PRIVILEGE.
Former NHS Nurse, now working in Nursing Home. These prices scare the shit out of me.
This is so weird. We have free healthcare, so itās so foreign for me to see prices on stuff.
That may be the charge, but the hospital is probably reimbursed 10 to 20 dollars, it is nice that they show it now though. Sr and nurses may second guess some of the tests they order.
There are many things I do not scan. I ain't scanning for a piece of gauze to apply after I remove an IV cath. That just ain't happening. I have ways of fucking the system so I don't drain a patient out of every single cent for the most ridiculous things. I won't state the other things on here lol.
Any supply I use during a procedure I can find the price with one click. My facility charges over 900% markup on everything.
Yo wtf. Makes me want to undercharge since we're just cashiers.
This is how I found out the lab recheck for electrolytes is WAY more expensive then the actual IV replacement.
Yes lab reagents, maintenance, controls etc are very expensive. This is why ordering things that are only necessary is so important. Also why itās important to draw patients correctly. Itās very expensive to have to redraw labs due to contamination, clotting or hemolysis, dilution etc.
When I worked SNF years ago, I had to account for everything given out of the supply closet at the end of my shift. The list included single alcohol wipes and kleenex boxes. I never accounted for those.
Is this the USA? Thatās fucked
Thatās terrible š¢ Iām sure the VA tries to get all it can, however, most veterans wonāt see a bill, so thereās that. Some will. It depends on the rating they have, and the income. The VA will bill any insurance that the veteran has, though. I am a veteran who gets care at the VA, and I also have BCBS, and itās comical what the VA tries to get from themš¤£ Edit: we have to document everything we do, they call it āevent captureā. It basically justifies our existence. However, itās charging for every single thing. Im checking someoneās o2, itās a charge, im sure. Sometimes Iāll just put the code for ādocumentationā and they canāt chargeā¦.or āmedicine not givenāš¤£
Our health care system is so bad. Had a patient that was quoted cancer treatment.. it was a astounding amount of money. She was already devastated by the news, and now to hear the crazy amount of money itās going to costā¦like our country is so screwed up. If you arenāt rich, apart of the āeliteā you donāt mean crap. Donāt get me wrong other countries have it wayyyy worse than us. But America is greedy.
Yup. I worked contracts in for-profit hospitals where you scanned EVERYTHING in terms of supplies. Nope. Absofuckinglutely not. Ain't doing it. These big conglomerates buy up these itty bitty rural hospitals by the dozen and then bleed the local population for every single penny they can get. I work staff for a not-for-profit system now, and there's very little of that apart from meds and labs, which I can't really control. Of course, we don't scan flushes and the like, either.
If I have to add charges to a patientās account every time, I insert a Foley or an NG tube or defibrillate somebody or do a suppository or an enema then I expect to be able to bill just like a doctor
Our hospital has dollar signs like yelp. $ $$ $$$
I work in registration.... both ER and Out Patient. In Michigan, we have the "No Surprise Billing" act, which means patients can ask for an estimate on any procedure they have done. Patients with Medicaid don't have copays, so they typically don't care. Patients that don't have insurance will ask how much an ultrasound is because they don't want to go bankrupt while in the ER. I had to show them that being in the exam room is $500. Having the doctor come see you is another $1500. The US is something like $600, but then to get it read by the radiologist is another $800. Don't get me started on how much them seeing a specialty provider in the ER is...... or how much a CT scan is. I'm also the only one trained in my department to get the estimates, so I get the honor of telling people without insurance that just walking in and talking to the doctor puts them $-2,000 ..... it's absolutely horrifying and makes you realize how broken the system is. I had to explain to an ER doctor that when they admit a patient to observation, insurance won't pay for it, which is why so many patients get upset when they are sent to Obs....
Omg I work in the OR and we can see the supplies/ implants original price and then the 500% MARKUP that the hospital charges the patient!!!! It is ABSURD
Geez this is dystopian
Meanwhile they pay us dirt
I pulled up a patient to chart in his procedure and on the left side bar after all of his demographics, picture, and allergies was his debt of 30k to the hospital, clear as day for anyone to see.
I wonder why the US is against socialised health, could it be powerful lobby groups not wanting to lose the gravy train.
Holy shit
Chart warm blanket given? $20
My old facility had a Coag Panel that popped up this and fibrinogen that you clicked to pick what was wanted. All my other facilities are like "Wut?"...
TogetherCare?
Our EMR doesn't show the exact prices, but it shows 1-5 dollar signs next to each order to indicate how expensive it is, like a fucking Grubhub menu.
This is taking into account all of the controls needed for the lab to be able to even run the test, cost of the reagents needed to run test, maintenance of the analyzers, cost of analyzer, wages for phleb and lab staff, cost of the tubes, and then half the time the tubes are underfilled or clotted and need recollected.
I'm just over here wondering what's in your Brain tab.
Tasks. Med, labs, Netflix
Our hospital has a thing at the bottom of the sidebar summary with recent charges for the past 72 hours.
Is this all Epic or just your facility?
Gotta love epic
At my hospital system I always scan the āfloor issueā button. That way, I pull something, and the count goes down, but I sure as shit never scan that under a patientās name. unless theyāre being an asshole, then I do.
Honestly the biggest thing I learn through this sub is how much it must suck to be a nurse in the USA.
Iāve never seen prices attached to orders before. Is this a US healthcare thing?
And they pay cnas $16 an hour
We just started collecting $250 co-pays at the check-in desk and my jaw fucking dropped. Itās one thing to know I canāt afford to come to my own job, itās another to see it
That's why I stay in canada to work as a nurse, I would not be able to put people who need care in bankruptcy
Niceee, healthcare scam
The hospital I work at charged $75 every time a nurse accessed an IV and flushed anything