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Physician Assistant Hires Physician Assistant Assistant to Help Manage Hospital Rounds.

Gainesville, FL -  Two years ago, Physician Assistant Stan Hanover P.A. was so overwhelmed with patients that he hired his own Physician Assistant Assistant (P.A.A.) team to better manage his rising patient load.  Rounding on 30 patients a day and admitting another dozen had become just too much for Stan to handle.

"I went to my Hospitalist group and said I need more money to hire my own team of Physician Assistant Assistants,"  said Stan.  "At first, they questioned the need for more help, until I told them the Dermatology clinic was hiring for days only, no holidays and no weekends  and they said I could have whatever I needed."

Stan spent several months interviewing dozens of potential candidates before hiring three pre-P.A. college students for the job.    "I even interviewed a few nurse practitioners for the position but they all thought they were interviewing to be my boss, so that didn't work out," said Stan.

After completing a one week hospital sponsored H&P course - usually reserved for surgeons who need help with a pre-op  H&P - the physician assistant assistants were certified by Stan to begin caring for patients.

"I used to get upset when someone called me an extender, but now that I have extenders helping me see patients, I can see 60 patients a day and still have time to take a one hour lunch break with the docs."

The Hospitalist physicians couldn't be happier.  "We've tripled our census in less than two years but we're doing less and less work.  Now I just have to wave to my patients from the door and move on," said Dr. Alan Jensen, who now bills for over 100 patients a day and usually finishes two hours early.

Patients don't seem to mind either.  Having a physician assistant assistant, a physician assistant and a physician see them daily really makes them feel like they're getting their money's worth.  

"Nobody really knows who's who.  We all have physician in our name, which really helps a lot with our patient satisfaction scores," said Dr. Jensen while being interviewed during his third lunch break of the day.

To really push the physician angle, Dr. Jensen has encouraged all team members to introduce themselves with emphasis on the word physician while mumbling or lip-syncing their assistant or assistant assistant title.  

Physician Assistant Assistants:  We're here to help you do more!
In addition, Dr. Jensen prefers only hiring males so as not to confuse patients.  "I'm not sexist.  I think women do an excellent job in medicine.  Unfortunately, when we hire women, patients think they are just a nurse and that really hurts our satisfaction scores,"  said Dr. Jensen.  

"I had to let all my female nurse practitioners go because we kept getting complaints from patients that only a nurse saw me today.  In fact we even fired our female Hospitalist physicians for the same reason," said Dr. Jensen.

Given the success of the P.A.A. program, Dr Jensen envisions having a fully functioning Physician Assistant Assistant Assistant and Physician Assistant Assistant Assistant Assistant program up and running in the next couple of years to continue improving operational efficiencies in an ever declining reimbursement environment. 

"In the next couple of years, I anticipate billing for at least 200 patients a day," said Dr. Jensen.



Frozen 2 Soon: The Anti-Vaxx Years Coming Soon!

Lake Buena Vista -- After the wildly successful Frozen franchise and ground zero to the largest U.S. measles outbreak since elimination was documented in 2000, the Walt Disney Corporation (WDC) announced the release of Frozen 2 Soon:  The Anti-Vaxx Years to capture the hearts, imaginations and wallets of an ever growing population of anti-vaccination families.

To compliment the movie, crews at Florida's Walt Disney World Theme Park have been feverishly working around-the-clock constructing the Frozen 2 Soon display at Magic Kingdom, where unvaccinated children and their vaccine averse parents can immerse themselves in a fully contagious experience with Influelsa, Tetanna, Meningolaf and other Frozen characters afflicted with highly contagious childhood diseases before vaccines became readily available  in the Kingdom of Arendelle.

Recent reports confirmed WDC had just started requiring proof of immunization before park entry, but a slew of subsequent lawsuits by anti-vaxx parents forced them to reconsider.

"We thought banning unvaccinated children - like guns and heroin -  from entering our park was a common sense policy that would allow millions of children to experience the magic of Disney without fear of contracting a potentially deadly illness because some parents in their own twisted minds believed not vaccinating their children somehow made them safer,"  said Walt Disney CEO Robert Iger.

"However, after careful consideration, WDC did not feel it was fair to the parents of unvaccinated children to exclude their little ones from the magic of Disney.  It's just not politically correct to exclude anyone anymore.  We hope the Frozen 2 Soon exhibit will recapture their hearts of the anti-vaxx community and we apologize for any pain and suffering our proof of immunization policy may have caused them,"  said Robert.

As proof of their sincerity, WDC promised 50% off park entry for unvaccinated children and free admittance for any child in the actively contagious stage of a vaccine preventable disease.

Anti-vaxx parents are thrilled with Disney's decision. A recent internet forum was abuzz with the incredible discounts being offered.   "All my kids wanted to go see the Frozen 2 Soon characters as soon as we heard.  My Allison says she can't wait to see Influelsa and Tetanna in their dresses while my  Jamie hopes to get a picture with Meningolaf and Polioaken together," said a defiant anti-vaxx parent going by the moniker Duke of Measleton.

"I'm hoping at least one of them gets measles or whooping cough before our trip next month to save us some extra money."

Frozen 2 Soon:  The Anti-Vaxx Years Coming Soon!
Despite the  excitement, the internet parent did express sadness for Robin, her third daughter being left at home for the family trip.  "I'm so angry at my pediatrician for accidently vaccinating her last year when I stepped out of the room to use the bathroom.  She would have loved too meet Hansophilus and scary Mumpsmellow snow monster, her two favorite characters.

Disney promised to provide a fully contagious experience for the diehard anti-vaxx community by working with the Centers for Disease Control and Prevention to obtain live virus samples of childhood diseases for injection by roaming Disney Characters  while listening to  Do You Want To Get Pneumonia?,  For the First Time Vaccinator, He's a Bit of an Anti-Vaxxer, and Let It Grow in the background.

"I'm just praying we get lucky enough to find the Meningolaf so my kids can experience the thrill of polio first hand.




Families Thrilled to Know Comfort Care Chemotherapy is an Option.

Boston, MA -  After years of poor patient satisfaction scores threatened to get Dr. Betty Jensen kicked off the medical staff at Monroe Hospital, she became the first Palliative Care physician in the country to start offering end-of-life comfort care chemotherapy last year and the results have been nothing short of remarkable.

"I could actually feel the tingling deep inside of my patient satisfaction scores rising in real time as patients called out for one last dose of deathbed comfort care chemo before passing peacefully on the vent surrounded by friends and family in the ICU," said Dr. Jensen, who went from worst to first after implementing her chemotherapy protocols.

But life wasn't always so good for Dr. Jensen.  "For years, I was living in fear of my next patient complaint.  Then it hit me one day.  I am a palliative care service.  Cancer patients seem to love palliative chemo.  It just made sense for me to start offering end-of-life palliative chemo to optimize the patient experience," said Dr. Jensen, who now works closely with several oncology groups to maximize her patient satisfaction scores.

At Monroe Hospital, every palliative care consult now gets an automatic oncology referral to make sure no end-of-life patient dies without chemotherapy.  For the last six months palliative care and oncology have been working side-by-side in a symbiotic relationship, maximizing end-of-life comfort care patient satisfaction scores.  Patients and their families have had nothing but praise for this aggressive approach to death with dignity.

"My mother was 92 years old and hadn't been in an upright position in three years.  We knew it was finally time for comfort care when the surgeon said enough was enough after  172 decubitus ulcer debridements failed to make her better.   We thought they would just pump her full of sleeping drugs and let her die a miserable death without food and water, but we were thrilled when the hospice doctor recommended comfort care chemo.  That's why we love this hospital so much. I just wish end-of-life comfort care chemotherapy was available when my father died.  We could have prevented so much suffering," said the daughter of one satisfied patient, who prides herself on being an excellent advocate for patient rights.
Comfort Care Chemotherapy provides peace of mind.

Dr. Jensen agreed.  "We used to tell families and patients about dying with dignity but that just got them all riled up.  Now we tell them about dying with chemo and their ears perk up.  They become excited to hear more.  They are thrilled to know end-of-life doesn't mean end of treatment.  And word must getting out about our great service because we've already been asked by several nursing homes this year to start providing end-of-life skilled nursing home chemo."

Finding the right mix of chemotherapy was not always easy.  Dr. Jensen spent many months trying to find the perfect combination of drugs for her protocols.  "Comfort care chemo is more of an art than an exact science.   In the early days, we caused a lot of unnecessary pain and suffering by being too cautious with our dose adjustments for age and renal function. But we got over that fear after time and time again our patients and their families told us not to hold anything back because their mother was a fighter."

Hospitalist vs ICU End of Life Palliative Care Video


Hospitalist vs Oncologist Video




Weather Forecasting Accuracy Joins Medicare Value Based Purchasing Program.

Baltimore, MD  -  Just days after Medicare announced their historic timeline for shifting fee-for-service  to alternative payment models that focus on quality and value and just hours after New York meteorologists inadvertently shut down New York City with their failed Blizzard of the Century forecast,  the Obama administration announced the addition of weather forecasting accuracy to a value added payment mix used to determine how much doctors and hospitals are paid.

"After careful consideration, we have determined that doctors and hospitals should be punished for inaccurate weather forecasts that affect the safety and wellbeing of our Medicare seniors and we plan to hold them accountable," said HHS secretary Sylvia Burwell during a conference call with reporters.

New York public transportation was ordered shut down by New York Mayor Bill de Blasio after meteorologists predicted several feet of snow would wreak havoc on the city.  That forecast proved grossly inaccurate and upset millions of residents caught without a way to travel about the city.

Bad weather forecasting now linked to Medicare penalties.
Many New Yorker residents were thrilled with the federal government's call to action.  "It's about time those rich doctors suffered for these ridiculous weather forecasts day after day. Those people have no idea how hard it is to plan a day around bad weather forecasts," said Tom, an uninsured street vendor  who gets his healthcare from a charity clinic staffed by volunteer doctors and nurses on their days off.

By tying the accuracy of weather forecasting to payments, Medicare continues to push the envelope on creative ways to blame doctors and hospitals for failing to control costs.

Next week,  Medicare will publish their highly anticipated list of future additions to the value based purchasing program which is expected to include 2016 payment penalties tied to satisfaction with local DMV services and the availability of power scooters during peak shopping hours at Walmart.



Elderly Woman Admits to Family She's Not Really a Fighter.

Tuscaloosa, AL -  Ethel Burman shocked her family this week after admitting to them she wasn't really a fighter after all. Despite their insistence over the years, the elderly nursing home patient told her family she's never been a fighter and all their talk about her being a fighter is just made up gibberish in their own minds.

"I just got tired of hearing my kids tell the doctors to do everything because I am a fighter and I snapped.  I'm not a fighter.  I'm 98 years old.  Last week I wrote a thank you card to my poop for being the only thing to show up on my birthday,"  said Ethel, who has suffered through debilitating illness at the nursing home for years.

Son always requests WTF order:  Wants To Fight
Ethel is known hospital wide for her frequent hospital admissions to intervene on any one of her dozens of chronic medical conditions.  Ethel is part of a close knit group of frequent flyers being kept alive at all costs by their family's grit and determination.  "I've taken care of Ethel for years.  Her son always makes us write an order for Wants To Fight.   I say to the son 'WTF?' and he nods his head yes," said Angela Hanes, a veteran nurse who has seen it all.

Angela admits the nursing team on pod seven prominently displays a constantly updated list of WTF patients so nurses can mentally prepare for their day of pain.  "We have an agreement on the floor that if we are assigned a WTF patient, we don't have take anyone else on that day.  They require 1:1 cares all day long," said Angela.

Despite his mother clearly expressing her wishes, Ethel's son spent hours trying to convince hospital staff she didn't know what she was saying.  "My mother is crazy.  I'm her POA.  I know what's best for her," said her son with a straight face and exceptional insight.



Illinois Small Businesses Should SHOP for 2015 Health Coverage

Small business owners: are you considering all available options to find a health insurance plan that works best for your business and employees?

One resource for Illinois small business owners is the Small Business Health Insurance Options Program, or SHOP, where employers can compare group health insurance options. The SHOP is open year-round for small employers to browse, compare plans, and fill out applications online.

The Benefits of SHOPping Around


Buying health insurance through the SHOP can help small businesses save money. According to the Robert Wood Johnson Foundation, total spending on healthcare by small businesses will decrease by 8.7% because of provisions in the healthcare law. Small employers that offer coverage through the marketplace may be eligible for a tax credit that can cover up to 50% of their employees’ premiums. The Small Business Majority’s tax credit calculator shows if small businesses are eligible for the credit and how much money they could receive.

There are even more benefits to buying a SHOP plan, because small businesses will no longer be charged more for female workers, who had been paying up to 50% more for their premiums before the healthcare reform law. In addition, employers will no longer pay more for workers with pre-existing conditions and will benefit from new limits regulating health insurance costs for older workers.

Health & Disability Advocates, a non-profit with 16 full-time employees, is an example of a small organization that used the SHOP and found a better deal. Both HDA and its employees gained – the non-profit is now spending approximately $20,000 less on healthcare, while its workers have lower premiums and have access to a wider network.

The Downside of Sticking With Your Current Plan


As many as 80% of companies with up to 50 employees opted to renew their non-compliant plans for 2014, and a similar percentage will likely try to do so this year. Small business owners who decide to renew their old plan may not save money and may instead see a price increase for 2015. This is why investigating all health insurance options, including those offered through the SHOP, could benefit small businesses. Many could save money by purchasing a plan through the health insurance marketplace, or through selecting a plan with better coverage for about the same cost.

How to Start


In order to begin the enrollment process and explore options, Illinois small businesses can visit the SHOP online, or contact a certified health insurance broker to assist with the enrollment process. The more small business owners know, the easier it will be for them to get their employees more-affordable insurance coverage. Once owners have found a reasonable option for their small business, they can stop worrying about health insurance and do what they do best – run the companies that make up the backbone of our state and our nation.

Jesse Greenberg
Director, West and Midwest
Small Business Majority

Don't Chip Away CHIP

Leaders, from Illinois and across the country, are calling on Congress to continue funding the Children’s Health Insurance Program by highlighting its success in reducing the number of uninsured children and warning that these children may lose coverage or receive less age-appropriate care.  The Children’s Health Insurance Program, or CHIP for short, offers developmentally appropriate healthcare for low-and-moderate-income children from families earning wages above the Medicaid threshold.  In Illinois, the program covers 219,000 children and pregnant women as of June 30, 2014.

The healthcare reform law funded CHIP until October 2015, but states need quick federal action as they plan their budgets for the coming year. Unfortunately, Congress may forgo CHIP funding, because children could potentially obtain health insurance through the health insurance marketplace. However, the health benefits in a marketplace plan may not equal those offered through CHIP, and families may not be able to afford the premiums and co-payments.

CHIP’s Benefits are Better

The essential health benefits in the marketplace’s qualified health plans can differ from CHIP’s; marketplace plans can either enact more stringent benefit limits or not cover important pediatric services. For example, a Government Accountability Office study of CHIP programs in five states including Illinois found that marketplace plans were more likely to limit pediatric services and that CHIP offered more generous ceilings for certain services.

Of special significance for children, marketplace plans are not required to cover pediatric dental services if a stand-alone dental plan is available. This means families might be forced to purchase a dental plan in addition to a general health plan for their children—increasing monthly premiums. Since the individual mandate would not apply to dental coverage, families may forgo pediatric dental coverage altogether.

Children in the Illinois CHIP program, All Kids, benefit from Early and Periodic Screening, Diagnosis, and Treatment services. EPSDT can identify medical conditions at an earlier and more treatable point in time and link children with necessary care. The benchmark plan for the state does not offer a comparable set of services. 

Higher Costs and Family Glitches

CHIP health plans, including Illinois’ All Kids, have better cost sharing arrangements than marketplace plans. Monthly premiums in All Kids range from $0-40, while the marketplace’s lowest cost bronze plan in Chicago had a heftier premium of $76 per month.

A report by the nonpartisan Medicaid and CHIP Access Payment Commission found similar patterns across the nation. According to the report, the actuarial value, or the costs covered by a health insurance plan, is generally lower in marketplace plans.

Parents and children forced out of CHIP plans would also encounter higher healthcare prices due to the ACA’s family glitch. The healthcare law bases affordable workplace insurance—and a family’s eligibility for marketplace financial assistance—on the cost of insuring individuals, not families. Parents are placed in the bind of being unable to afford their employer’s family plan, because that option involves much higher costs, but cannot qualify for tax credits or subsidies.

Stick with CHIP

Advocacy groups and leaders from both political parties have called CHIP a success. Since its creation in 1997, the program has increased the number of children with health insurance: 8 million children were enrolled in 2012 alone. The program has contributed to the marked decrease in the percentage of uninsured children, which has fallen from 13.9% to 7.1% over the past 17 years. Because of CHIP’s proven track record and uncertainty surrounding healthcare options in a post-CHIP era, Congress needs to continue funding this important program.

Bryce Marable, MSW
Policy Analyst
Health & Disability Advocates

Hospitalized Woman with New Complaint Everyday Diagnosed with Broken Furnace Syndrome.

Fargo, ND - Bertha Jensen was hospitalized two weeks ago for chest pain rule out, but a new complaint every day has prevented doctors from sending her home during the cold winter months.  That is, until a breakthrough in discharge planning was discovered by her current Hospitalist.

"When I was a resident in Minneapolis, I took care of at least a dozen cases of Broken Furnace Syndrome every winter," said Hospitalist Dr. David Penter, who is known for his uncanny ability to spot patients with ulterior motives from a mile away.

Broken Furnace Syndrome is any 12/10 symptom that presents during a patient-doctor encounter on the day of planned discharge from the hospital, followed by a completely unrelated symptom after the physician minimizes the first complaint. For example, having a 12/10 headache that is then followed with a complaint of diarrhea after the physician minimizes the headache complaint  is pathognomonic for Broken Furnace Syndrome.

Broken Furnace Syndrome occurs in the cold winter months when patients refuse to go home because of problems with their utilities or other social dynamics that have nothing to do with their hospital stay.  While often the result of a broken furnace, physicians should also consider variations of the disease in their differential diagnosis, including I Didn't Pay My Gas Bill, My Pipes Froze and I Don't Have Water and even My Mother-In-Law Is in Town and She Thinks She's Going to Stay With Me as the reasons for avoiding discharge.

Every time Bertha's doctor told her she was stable for discharge, a new complaint was suddenly described.  "We ruled her out for MI in less than 12 hours and 12 days later she's still laughing it up with the nurses, except for the three minutes the doctors are in the room, then she's complaining of 12/10 nausea,"  said Dr Penter.

A normal litany of complaints for an 88-year old has kept Bertha hospitalized for nearly two weeks, including headaches, nausea, chest pain, blurry vision, sore throat and restless legs.  On day seven of her observation stay, she even complained of diarrhea and constipation in the same night.

Consider Broken Furnace Syndrome for difficult winter discharges.
On day four of the observation stay, one hospitalist tried to put an end to the madness by spending four hours - on a Saturday - coordinating a stat laprobroncathoscopy between the surgeon, pulmonologist, cardiologist, gastroenterologist, anesthesiologist and pathologist, in anticipation of a Sunday discharge.  Despite everything coming back normal, her Sunday discharge was aborted after she complained of not having a ride home.

Dr. Penter confirmed the diagnosis by having his medical student stand outside Bertha's room all day listening to her phone conversations for clues.  This allowed Dr. Penter to get his work done while making the medical student feel important.

"We caught her taking to Dan the Furnace Man at around 3 p.m. yesterday.  When I presented my findings to her, she complained of 12/10 restless arms, followed by a lump in her throat that she wanted thoroughly checked out."




Am I a Good Parent? Two Question Quiz!

Many mothers and father often find themselves wondering whether they are good parents or bad parents.  The answer is really quite simple.   If you vaccinate your children and you don't spank, you're a good parent.   Good job parent!  If you vaccinate your kids but feel it's alright to spank them, you're a bad parent.  Stop it!  This flow chart diagram on parenting skills will help you understand.  Be a good parent.  Vaccinate your kids and don't spank them and you'll be a great parent.

photo bd9cdefc-02b9-4e0d-b74e-16dbe073f588_zps3b447057.jpg


You can find many great books on Amazon about gentle parenting techniques that provide a positive experience for your kids.   The Happy Hospitalist is hoping 2015 will be filled with great parent experiences that bring joy to your childrens' hearts.  Fill their love tanks.  Say no to spanks and yes to vaccines.



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