I took over going to Baptist Health Extended Care quarterly meeting years ago, when Shaver became chief. We get paid 150 bucks per meeting so I try to attend. Gail McCracken used to run it, but Bob Searcy took over a couple of years ago. It used to be at BHEC, then it was where the vaccines are given out now near the Dr. Lounge. Now it's in a new place every time, and this time it was quite cryptic. Behind the glass door. In the small conference room. I found it, in the admin suite, and made it on time. Greg is the admin - he used to run the lab before Cody took over.
Ken Robbins is always there, and Greg Zawada. Ali usually comes, but he was absent. There is a pharmacist - she is constant, but the three nurses, all of whom I respect, were new to me. Damn travelers, said Bandy last week, when he sent for frozens but it was not communicated to the gross room and so they didn't get done. The entire hospital is made up of travelers. Radiology is a complete mess - it's a wonder we actually get specimens.
The meetings have a routine - first the pharm approves new meds and we motion to approve and second the changes. Bob wandered in late because he got lost. One of the nurses presented a routine they were doing to measure the room cleanliness. She was talking about ATP and call buttons and phones and we were all lost. Bob stopped her. You mean Adenosine triphosphate? And what phones? Telephones, I told him and he incredulously wondered if there were telephones in the patient rooms. Yes, said the head nurse. Who uses these phones? Zawada googled ATP measurements and sure enough it was a thing. Bob said no disrespect, but we need more information here. The nurse said none taken, I'll bring more information to the next meeting.
So then the infection control nurse presents the CLAUDIs and the CLABSIs and she mentioned there was a C.Diff. Admin Greg said we get a 2% ding from Medicare for that. Bob wondered for just that patient? Or the whole year? The whole year, Greg confirmed and we all gasped. Bob said who is making this stupid rule? Tony Fauci? Clearly no one that knows anything about medicine. It's like we are living in Infinite Jest.
That played out again when Greg said our Case Mix Index is going down and that is bad for reimbursement. What is CMI? We all wondered, and Greg said patient acuity. There's been a lot of young patients with COVID being admitted and they don't have as many comorbidities. Value based care! I announced. Didn't we have a mandatory meeting about that last night? I have yet to watch it, but I have two weeks.
Greg explained that they needed more critical patients to get better reimbursement. Bob said well I could probably diagnose everyone in this room with sepsis. Anxiety. Depression. I see you Greg, I'm not asking you to cheat the system (we all laughed) but we need smart people to help us game the system. They've got all the Ivy Leagues, none of whom know medicine, so we've got to get those too. It's a new game, it's terrible, but we've got to play it.
The meeting adjourned and I asked Bob if he'd ever watched the movie about David Foster Wallace. He remembered yes! The reporter who goes to interview him. They talked about tennis. I tried to start Infinite Jest but decided to save it for retirement. It's like Finnegan's Wake. Same here, I told him. Couldn't get past the first chapter. But that Kenyon College graduation speech? I read it in residency it's one of my favorite pieces on the planet, I told him. Yes I read that too.
Having an amazing weekend. Pool is heated and family gatherings are aplenty. So happy to be off next week. I've got three cling on cases to finish up Monday but going in when you are not actually on is a pleasure. Happy Sunday, much love, Elizabeth