My concerns about the ACA
Let me start by saying, my two main concerns are quality of care and profit. I'm going to be graduating with my BSN in 2.5 months and entering the field shortly after. I take this job very seriously, but I won't do it if salaries are cut or the workload grows to levels that are dangerous for both the patient and myself. In my area, they have cut out nigh shift differentials, are eliminating Techs, and in certain areas up north, environmental services. RNs are now required to do these jobs. Nursing is a very difficult field and despite the fact we love being there for people and give so much of ourselves to our patients (I like to imagine most of us do!) we are still only human. Very few of us are so in love with the profession that we would work for much less money, given the job intensity.
Anyways, there is a reason for my concern,as there are some issues with the ACA that have a high likelihood of throwing a wrench in the gears. I want to say that reducing hospital acquired infections is one of the most important issues hospitals are battling. "Provider preventable condition" are not going to be covered by insurance, but the absolutist nature of this provision is troubling. Say someone falls and breaks a hip by their own fault, the hospital now has to eat those costs. So any patient that becomes a fall risk will have a higher likelihood of being put on restraints, which now increases their risk of becoming incontinent which rapidly ups their risk of developing a pressure ulcer (which stage III and IV are not covered). Now, anyone who has a few weeks of education in the healthcare field knows they only develop with severe neglect, but now either the RN or ACT, if they haven't been eliminated, has to spend time going in the room and turning this patient who may be on restraints because they are a falls-risk (god help you if they are on isolation). Time is valuable in this field. Very valuable.
You can tell me that they won't keep people restrained, but I would not be so certain, because healthcare providers do all sorts of crazy shit to cover their asses. Look at the absurd number of diagnostic tests run to prevent lawsuits. And the bigger problem is that if hospitals lose money, they cut staff pay, particularly nurse pay (the group that costs the most). RNs don't like that. They leave the field over it.
Just want to voice my concerns! I think everyone having access to insurance is a mare velour thing, but by nature, I consider everything.
= new reply since forum marked as read
I've been on DU for over a decade. I know exactly what you're up to, and so do you. So, I'm back to...
First, it should be understood that this applies to Medicaid payments only (if I am correct in reading the rules--yes, there are a few preventable conditions that pertain to any hospital setting: like performing the operation on the wrong patient!). You've conveniently left out things that are truly provider errors or neglect--things like operating on the wrong body part (it happens) or leaving a foregin object in someone's body after surgery (happens a lot). It is critical that we reduce these avoidable issues, like UTIs due to an improper catheter and surgical site infections.
Here are a list of the PPCs:
Foreign Object Retained After Surgery
Air Embolism
Blood Incompatibility
Stage III and IV Pressure Ulcers
Falls and Trauma; including Fractures, Dislocations, Intracranial Injuries , Crushing Injuries, Burns, Electric Shock
Catheter-Associated Urinary Tract Infection (UTI)
Vascular Catheter-Associated Infection
Manifestations of Poor Glycemic Control; including
iabetic Ketoacidosis, Nonketotic Hyperosmolar Coma, Hypoglycemic Coma, Secondary Diabetes with Ketoacidosis, Secondary Diabetes with Hyperosmolarity
Surgical Site Infection Following:
Coronary Artery Bypass Graft (CABG) - Mediastinitis
Bariatric Surgery; including Laparoscopic Gastric Bypass, Gastroenterostomy, Laparoscopic Gastric Restrictive Surgery
Orthopedic Procedures; including Spine, Neck, Shoulder, Elbow
Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) Following Total Knee Replacement or Hip Replacement with pediatric and obstetric exceptions
Category 2 – Other Provider Preventable Conditions (For Any Health Care Setting)
Wrong Surgical or other invasive procedure performed on a patient
Surgical or other invasive procedure performed on the wrong body part
Surgical or other invasive procedure performed on the wrong patient
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Financing-and-Reimbursement/Provider-Preventable-Conditions.html
ETA: I'm not normally so dismissive of a new poster but you really should learn something of the culture of the board before you drop what seems to be a serious post disguised as a turd into our little punchbowl.
Your title is a major negative cliche here...
http://rationalwiki.org/wiki/Concern_troll
