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Marijuana Doctors' Lounge at Colorado Hospital is Nation's First.

Denver, CO -  Brooks Hospital holds the honor of being the first and only medical facility in the country to offer a full service marijuana physician lounge and doctors say they wouldn't have it any other way.  Shortly after Colorado legalized possession of one ounce or less of recreational marijuana, the private physician area was opened at the urging Dr. Jeffrey Potter, a Hospitalist upset with the declining diagnostic skills of his fellow colleagues.

"I was shocked at the number of H&Ps and consult notes that had 'heart problems' or 'vision changes' as the final diagnosis.   I knew a little marijuana could go a long way to improving the differential diagnosis skills here at Brooks,"  said Dr. Potter.

In 2012, the medical community was taken by storm when Dr. Potter diagnosed a case of Dilaudopenia and Polybabydaddia during his first hour on the job.  "That's the week I bought an ounce of Trainwreck," said Dr. Potter, who believes his smoking is protected by medical marijuana laws.

The revamped physician gathering area - known as the The Weed 'n' Feed -  was opened as a quality improvement project just weeks after Dr. Potter joined the staff.  "I knew I'd have no problem getting a pot lounge set up because every day I'd hear a doctor or nurse say 'What the Hell is administration smoking'."

The hospital's physician lounge comes stocked with a full assortment of marijuana flavors, colorful pipes, 4-way bongs and dozens of plants cared for by a different specialty every week, with the exception of Palliative Care.

"Last year we accidentally assigned cardiology and nephrology to care for the plants at the same time.   They argued for a whole week about how much water to give and we almost lost them all," said Dr. Potter.

Proponents of the unorthodox physician lounge point to a dramatic improvement in the diagnostic skills of medical staff members.    Doctors gather in the lounge at all hours of the day and night, taking hits and bouncing ideas off other physicians who often drop in during rounds for a mental boost on their difficult cases.

"Since the lounge opened, we've seen a 400% increase in our cases of Ridiculitis, Status Dramaticus and Terminal Fibrocryalgia, allowing our hospital to collect millions of dollars in higher fees for severity of illness adjustments," said Jane Wymore, Director of Quality Documentation at Brooks Hospital.  "And the average word count of our surgical notes has increased from 7 words to 15 words, a remarkable feat by any standard."

Physician smoking marijuana in doctors' lounge
The Weed 'n' Feed Lounge has helped many physicians on the fence.  For example, ER doctors frequently visit the lounge to decide on a diagnosis of CHF vs COPD vs pneumonia.  "While taking hits with the Hospitalists last year, we discovered a combo pill called Lasofloxalbuterol.  The pharmacists told us it didn't exist, until we started inviting them to our lounge.  Now it's the most frequently ordered drug on our formulary," said Dr. Helen Smelter, an Emergency physician who almost had a heartastroke when the drug went on shortage last year.

For those doctors too busy to stop in the lounge, the hospital gives volunteer credit hours to pre-med students for transporting weed from the lounge to doctors and surgeons on the go.   "We even have one plastic surgeon who always takes a hit just before the opening incision to make the cut as cute as possible," said Jane Wymore.  "Her patient satisfaction scores are through the roof."

While most specialties have flourished, Jane says the orthopods continue to be the most challenging group.  "No matter how many hits they take, we still can't get them to write anything other than 'broken bone' in the chart.  In fact, we even had one unretired ortho doc write 'broken liver bone' after reading an abdominal ultrasound by mistake."

However, hospitalists are thrilled that orthopedic surgeons now come to the hospital at all hours of the day and night to admit their healthy hip fractures.  "Ever since the marijuana doctors' lounge opened, I haven't diagnosed a single case of Too Old To Admit To Ortho,"  said Hospitalist Jeffrey Potter.

Despite all the benefits, Jane Wymore says the hospital was not prepared for the unintended consequences.  "We had to triple the food budget in the doctors' lounge and put better locks on the doors after catching several patients in the lounge looking for fresh air.  And we upset a bunch of our medical staff when the chef said no to marijuana brownies."

"Lasofloxalbuterol:  When you just can't decide between CHF vs COPD vs PNA."


Lasofloxalbuterol.  When you just can't decide between CHF vs COPD vs PNA photo medical humor meme photo.



Santa Cancels Visit to United States; Cites Strict New OSHA Regulations.

North Pole -- Santa Claus canceled his annual Christmas Eve visit to the United States to avoid strict new Occupational Safety and Health Administration (OSHA) regulations that would have required him to trim his beard to less than two inches.  Earlier this year, OSHA passed regulation 29.63.23 requiring all humans passing through a chimney in the course of normal work duties to keep their facial hair less than 2 inches long.  Failure to comply would result in a $10,000 fine per incident.

Advocates claim bearded chimney accidents result in tens of thousands of accidents a year, including facial burns, traumatic falls and soot mouth, a rare but fatal condition for workers in the chimney industry.

Will Ferrell, Director of North Pole Operations, confirmed today Santa has canceled all home visits to children in the United States on Christmas Eve.  "Leave it to OSHA to ruin everyone's day.  What's next?  No food or drink at the nurses station?  Give me a break!"

Santa tells OSHA to get lost!
This will be the first year ever Santa has canceled his trip to the United States.  Kids in other parts of the world can rejoice in having all those extra gifts handed out on Christmas Eve.  One mother in West Africa felt sad for American kids but was thrilled at the prospects for her Ebola stricken neighborhood. "As soon as I heard Santa canceled America, I put in dibs for the Thomas TrackMaster Engine Set and a Dora doll for my kids."

Santa showed little remorse for his decision to cancel America.  "This reminds me of the time they tried to make me shampoo my beard after every home visit  to prevent the spread of lice.  As far as I'm concerned, OSHA can kiss my butt.  I've got plenty of business without America."

Santa has never had his beard trimmed, with the exception of of 1983, when an ICU nurse shaved it clean after he was intubated for high altitude sickness.  "That was a bad year,"  said Santa.



Hospital Avoids Bankruptcy By Building Toy Aisle at Entrances.

Chicago, IL -- Piedmont Hospital posted record profits last month by forcing all visitors to pass through a series of reconstructed  hospital entrances containing aisle after aisle of the most popular toys of the season. In less than a month, over two million dollars in profit was  generated selling Thomas trains, Elsa dolls and dozens of other must-have children's toys to families trying to keep screaming children from creating a scene as they pass their favorite toys on the way to visit their grandpa in the hospital.

Hospital officials were just  months away from laying off dozens of nurses to finance continued administrative operations when floor nurse Janice Berrymore put the toy idea in the suggestion box.

Many parents of young children quickly learn how to map their way through big box stores, steering clear of the toy and candy aisles to avoid scenes that are sure to follow.

If you want to see grandpa, you'll have to buy a toy!
"I gave up baby shopping at Target years ago because they always put their toys right next to the diapers and the baby wipes. I couldn't walk out of their without a new action figure or a tantrum," said Janice, who now does all her shopping on Amazon.

By forcing parents to walk their kids into the heart of their favorite toys, hospital officials hope to capitalize on parents trying to keep the peace while visiting their loved ones in the hospital.

"I find most parents will simply buy the Elsa doll rather than deal with a Target tantrum," said Devin Getter, a volunteer who wonders the toy aisle with suckers and condolences.

While most first time visiting parents will simply throw their hands in the air  and buy whatever their kid wants, some returning families have tried to bypass the toy aisle by resorting to drastic measures.  One family was even caught with three little kids zipped up in a suitcase trying to scurry  their way through the toy aisle.


Employers: Dropping Group Health Insurance Could Cost You

Looking ahead to 2015, many employers are deciding how to respond to the rising cost of employee group health insurance premiums. A study of employers by the large consulting group Mercer suggests that “the per-employee health benefit cost will rise by an average of 3.9% in 2015.” Although this is moderate compared to past premium-increase trends, “two-thirds of respondents say they will make changes to their health plans next year to rein in cost growth.”

Using Cash Pay-Outs Instead


To control costs, some small employers are considering dropping group coverage altogether. In a recent article by the Wall Street Journal, WellPoint, Inc. reported that “its small-business-plan membership is shrinking faster than expected and it has lost about 300,000 people.”

Many small employers are instead planning to offer a cash payout – a lump-sum of cash – for employees to purchase coverage on their own or through the new ACA marketplaces. While this may appear an attractive way to rein in health insurance costs, employers must consider the tax implications for employees and their organization. Taken together, cash pay-outs will actually increase costs overall for both employers and employees.

Employees Will Pay More...


Group insurance is a better deal for employees. With group health insurance, the amount that an employer pays towards an employee’s health insurance is not counted as taxable income. In addition, employee premium contributions can be withdrawn pre-tax directly from their paycheck. This substantially reduces the employee’s overall taxable income and the income tax they will pay. The example below shows the monthly take-home pay for a person making $6,250 per month who participates in an employer-sponsored group health plan.


As the example indicates, the employee’s net pay is $3,955. In comparison, if the same employee instead received a cash pay-out to purchase health insurance individually, they would make $3,595 per month. Example 2 shows how employees will end up paying more in taxes and more for their insurance when a cash pay-out is used.


As you can see, cash pay-outs will reduce overall employee compensation. When employees give workers cash to pay for their own health insurance, the money increases their gross income and in effect the monthly taxes they must pay. Additionally, the money directed toward employee premiums cannot be withdrawn pre-tax from their paycheck.

The real numbers will change depending on premium costs, tax brackets, and income level, but the message is consistent: employees will lose money. Employee Benefits Corporation has a great calculator tool that helps individuals understand the personal impact of pre-tax benefits.

... And So Will Employers


Because cash pay-outs increase employee gross income, the amount that the employer must pay in state and federal taxes will also increase. In our example above, when the employer offered group health insurance, the employee earned a base monthly salary of $5,650. In the second scenario, the employee’s monthly salary increased to $6,850. Employers pay on average 7.65% of their monthly payroll for Social Security and Medicare. For the employer providing group health insurance, the cost for Social Security and Medicare is $432; the employer offering cash instead of benefits would pay $524. This results in a difference to the employer of $92 per month – just for this one employee.

Higher salaries created by cash pay-outs also mean higher workers compensation costs, and short-term and long-term disability insurance. Since workers’ compensation replaces a portion of the employee’s salary, the higher the salary, the higher the costs. The same is true for short- and long-term disability insurance, which replaces all or part of employee salaries.

Stick With Group Health Insurance


Before quickly migrating to cash payouts employers should quantify cost implications for themselves and their employees. This calculation can complicate and lengthen the decision making process – but it is time well spent in the long run. If the goal is to reduce financial burden, using cash pay-outs ultimately creates the opposite effect and the promised reduction in costs is an illusion.



Michele Thornton, MBA
Insurance and Benefits Consultant


Product Review: The Nice Voice Surgical Mask

Boston, MA --  Healthcare professionals have reason to rejoice with TLC Industry's new language  transformation filter - The Nice Voice - that promises to allow medical professionals to speak their minds without fear of losing their jobs.

The Nice Voice was created by Robin Hruska, a hospital floor nurse reprimanded last year for telling an attention seeking  20 year-old female admitted through the ER with generalized weakness - after she refused to go home and take care of herself - to put down her phone, stop being a whiny little brat and get her ass out of bed.

Though it looks exactly like a surgical mask,  The Nice Voice contains hidden proprietary electronic circuitry that can sense angry, mean or cynical comments in real time and transform them into beautiful streams of poetic complements.

"I thought it was ridiculous that I couldn't say whatever was on my mind at work,"  said Robin, who never missed an opportunity to provide witty commentary after a patient-family-doctor tirade.

Now with her Nice Voice, Robin can tell it like it is. "Even though I'm surrounded by idiots all day long, I feel true to myself saying what I'm thinking without fear of losing my job." said Robin, who's colleagues actually miss her edgy attitude, except for that one little snitch in every bunch.

Robin's first post marketing test of The Nice Voice worked amazingly well.  While talking to nurses John and Brenda at a rare lunch break, Robin said, "Did you see that slutty Facebook picture of Cindy yesterday?  What a whore."  But what John and Brenda actually heard was, "Cindy is one of my best friends and I would waste Dilaudid with her anytime."

While some patients may wonder why their nurse is wearing a surgical mask, Robin says this concern is easily alleviated by telling the patient they got the flu from their flu shot and refuse to get one again.  "Patients are well aware of the flu shot causing the flu and understand that angle completely," said Robin.

The Nice Voice also works well in communicating with difficult doctors and surgeons.   Robin says she is constantly asking for orders to control her old-naked-roaming population.  She recently spoke with a Hospitalist to request wrist restraints but was told no.

Never let honesty get you in trouble again.
Robin told the Hospitalist, "Give me wrist restraint orders or I'm going to be your sh*t storm for the rest of your life."  But what actually came out was, "I'm thankful for the excellent care you and the rest of your Hospitalist team provide day in and day out in a very difficult and challenging environment."

One surgeon going through his 7th mandatory sensitivity training class in two years tried The Nice Voice for one day and will never go back to the way life was before.  "I just put on my Nice Voice surgical mask every morning and relive the good old days,"  said the God-surgeon.

Robin gave the mask to several nurses on her floor and they too were amazed at how therapeutic it was to say what they actually want to say without worrying about hurting the feelings of some emotionally unstable patient or colleague.

Jenny Armstrong, a new graduate nurse, who is currently molting from kind and caring nurse to burned out and cynical nurse, gave The Nice Voice a try and found a new inner peace with saying what she meant.

"Go home lady.  You're driving me crazy!"  Jenny told a hovering wife who wouldn't leave the room.   But what the lady heard was, "Your husband would be grateful to know you never leave his side in the hospital.  You are his shining light during times of pain and suffering."

Down in the ER,  Dr. Frank Fillmore was amazed at how good The Nice Voice made him feel by not having to be politically correct all day long. 

When dealing with a crazy lady interrupting his football game,  Dr Fillmore said, "Your pathetic pseudoseizure attempt is giving me pseudoseizures."  But what she heard was, "I thank you for choosing our hospital for your healthcare needs.  We know you have many choices and we are honored you chose our hospital to seize with us."

Robin says she's considering using The Nice Voice in public too, especially at Walmart.  "I was in a checkout lane at Walmart when some lady pulled out 72 coupons, her checkbook and a bag of pennies. So I put on my mask and let her have it.  But what she actually heard was 'Merry Christmas.  Take your time.  I have nothing better to do.'"



Chart Attacks a Leading Cause of Death Among Nurses.

Boston, MA -- Nursing is one of the most dangerous jobs in America, but the reasons may surprise you.  Most nurses have been kicked, punched, scratched, spit on, pooped on, bit on, hit on or called names at some point in their career, but physical assault was not the reason nurses cracked the top ten list for most dangerous jobs in America.

An epidemic of chart attacks is sweeping through hospitals with alarming speed, afflicting thousands of nurses with deadly consequences.  A chart attack - often mistaken for a heart attack - is the collection of signs and symptoms that occur during nurse charting opportunities, defined by researchers to include any nurse at work and any nurse with a computer at home.

Symptoms include the sensation of an elephant sitting on the chest,  left arm pain, shortness of breath, nausea, diaphoresis, lightheadedness, syncope or being irritated by something.  An elevated troponin is often found with ECG changes, including tomb-stoning ST elevation and runs of VT-VF alternans.

After reviewing data from thousands of hospital EHR systems, researchers found a direct correlation between nurses who had presumed heart attacks and nurses who chart, leading journalists to  publicly declare that charting causes chart attacks and labeling chart attacks as a cute new leading cause of on-the-job injury in America.

Researchers discovered hundreds of cases where hospital rapid response teams (RRT) were called to assist charting nurses, including Ben Fester, a 47 year-old nurse with three cardiac stents last year.

"We just thought he was exhausted from documenting accurate I's and O's," said Tonya Bedder, the rapid response nurse who found Ben face down while charting that he didn't have time to finish charting.

Health and Human Services used this research to declare electronic documentation as wildly successful.   "This is the clearest example so far of the benefits of electronic health records.  If not for the heroic documentation efforts of our nurses,  we would have never known charting was killing our nurses," said HHS Secretary Sylvia Mathews Burwell, who subsequently signed an order requiring all nurses to chart their chart attack symptoms.

Charting now feared as workplace hazard
Some nurses were surprised at their misdiagnosis of heart attack.  "You mean I had four stents followed by a five  vessel cabbage for nothing?" said nurse John Flemming, a 2-pack-per-day smoker who always volunteers to take all the patients out for fresh air and now believes he was actually having a chart attack when his symptoms hit.

To treat a chart attack, researchers recommend nurses stop charting or stop thinking about charting for five minutes, and then try again to see if the symptoms return.  They urge against seeking medical care, as this would interrupt the nurse focus on completing all necessary charting activities.

However, nurses complained this recommendation was not realistic.  "Our hospital policy says if we stop charting, we get fired," said John, who had just finished charting a respiratory rate of 20 on all his patients.




Why Narrow Networks are a Big Deal: A Discussion of Network Adequacy


A network is defined as the healthcare facilities, professionals, and suppliers that an insurance carrier has contracted with to include in a given health plan. Network adequacy is the extent to which a health plan has a satisfactory number of primary and specialty healthcare professionals that consumers can access in a timely manner.

The terms network and network adequacy are pretty technical words, so the average consumer may not know their definition, but a percentage of the population is even unaware of how to apply these terms to the process of purchasing a health insurance plan. According to a Commonwealth Fund survey of marketplace shoppers, 25% said they did not know the quality of the network for their health insurance plan. The survey results indicate that consumers may lack an awareness of how network adequacy impacts them on a personal level.

Consumer Problems with Network Adequacy

Consumer awareness is important, because network adequacy can have a tremendous influence on a patient's quality of care. For example, plans can include a hospital in their network, yet exclude doctors or specialists working at that hospital. As a result, patients may unknowingly receive care from an out-of-network doctor and be left with an exorbitant bill. This practice, in which consumers must pay the costs beyond the allowable amount determined by the health insurance company, is called balance billing. Sometimes the lists of healthcare professionals in a network are not even accurate, which may lead consumers to enroll in a plan that does not have their desired provider. Also, hospitals serving special populations, such as children, have reported difficulty being included in networks – preventing families from getting needed care at a reasonable cost.

Network Reforms Proposed

These issues may soon change. The National Association of Insurance Commissioners (NAIC) recently released a new draft model law for states, which has proposed some significant reforms. To begin with, hospitals would need to develop a process for alerting patients in cases where they may be seeking treatment from an out-of-network provider who happened to be working at an in-network hospital. In addition, insurance carriers would be required to update changes to their provider networks on a monthly basis and must make this information available online and in print form.

NAIC's draft model law also created the general recommendation for states to create sufficiency standards accounting for elements such as the amount of specialty services available, geographic accessibility, the number of providers, the wait time for receiving care, and the hours of operation for participating providers. NAIC gives states latitude in how they apply their sufficiency standards. However, NAIC does note that some states have chosen to adopt quantitative standards that set minimum numbers for providers for maximum travel times and maximum waiting times, among other metrics.

Changing Consumer Experiences for the Better

The reforms requiring insurance companies and healthcare providers to communicate accurate and timely information on healthcare networks are a much needed help for consumers who lack basic knowledge of their options (which may be due to the fact that they hate shopping for health insurance). Mandating more open lines of communication would simplify the process of finding and using health insurance. With readily available information, consumers would know what providers and hospitals are a part of their plan. Importantly, state actors are recognizing the significance of empowering consumers with knowledge, as the Illinois Department of Insurance recently released fact sheets on networks and out-of-network benefits.

Beyond improving communication with consumers, NAIC’s draft language on sufficiency standards would support consumers who have purchased a plan in having the ability to access the healthcare providers they need to stay healthy – without traveling great distances or waiting long periods of time. Advocacy needs to be done at the state level to guarantee that the sufficiency standards in place are in line with the intentions of NAIC’s draft model law and create quantitative metrics to determine a network’s strength.


Bryce Marable, MSW
Policy Analyst
Health & Disability Advocates

Hospital Weights Adjusted Downward After Thanksgiving, Scoring Patient Satisfaction Win!

Memphis, TN -- A nurse at Grover Hospital struck clinical gold Monday by recalibrating hospital scales back 10 pounds, 20 pounds, 40 pounds, even 100 pounds and more - in the weekend  aftermath of Thursday's annual Thanksgiving Day bing - to try and win the third annual Most Improved Patient Satisfaction Scores Floor Contest.

Customers admitted after the holiday feast will often complain to nurses they gained too much weight gorging on turkey and stuffing.  So Brian Jamison, the good looking male nurse known hospital wide for his inappropriate comments, decided to take matters into his own hands.

"I was assigned  Gerty, a 90 year old with CHF and TOADS* who went on and on about gaining 10 pounds after Thanksgiving and lamenting about her days as a 120 pound Roxette while I was trying to enter yes-no questions into the EHR.  I could see my patient satisfaction scores declining before my eyes," said Brian, who's amazing pornstache sealed the win for his floor's No-Shave November contest among the male and female nurses.

Brian was not about to let a lodl** ruin his chances at winning another holiday contest, so he quickly zeroed out Gerty's scale at minus 10 pounds and helped her up.  "The scale says you've lost five pounds this week.  Way to go sexy!  You're ready to dance!" he said with that special murse pornstache smile.

"I don't know where I am or what's going on, but I just felt butterflies under my skin after that good looking young man told me I lost five pound," said Gerty, who somehow works her way out of four-point leathers and wanders the halls buck naked every time she gets admitted.

With Gerty's success behind him, Brian's ambitions for perfect patient satisfaction scores grew with every patient, racking up over 247 pounds of weight loss satisfaction gold in just one 12 hour shift.  "I had patients sending ME flowers before my shift was even over," said Brian who normally feels bad for the other nurses when a homeless, one-legged, drugged-out meth addict gets more flowers in the hospital than most of his colleagues get in a year.

Some doctors were mildly concerned, albeit briefly, about the effect inaccurate weights might have  on their patients' safety, but then quickly realized happiness always comes first.   "On one of Brian's dialysis patients, I had to add 17 kg of volume during his Saturday run after he lost nearly 40 pounds the day after Thanksgiving.  He ended up on a ventilator with a cardiology consult for reverse aquapheresis management, but the last thing he said was 'Give me that satisfaction survey.  You're getting all fives',"  said Dr. Henry Allensworth, a nephrologist who who normally carries his own scale with him as a substituted for hospital wide inaccurate I's and O's,  but forget it this fateful weekend.

One gastric bypass candidate actually canceled her surgery scheduled for next week when Brian informed her of a miraculous 170 pound post-Thanksgiving weight loss achievement while hospitalized for acutely chronic bilateral non-celulitic cellulitis.

Unintended consequences of weight adjustments were popping up everywhere.    Pharmacists were forced to use a modified Cockcroft-Gault creatinine clearance formula using a Coefficient of Brian (CoB) to account for his unorthodox, but highly successful, patient satisfaction initiative.
 Modified Cockcroft-Gault CrCl = (140-age) * (Wt in kg*CoB) * (0.85 if female) / (72 * Cr)
Results on Brian's floor were nothing short of remarkable.  Average body mass index dropped over 30 points, causing a loss of $600,000 in Medicare reimbursement for morbid obesity as a complicating condition and mortality rose 14% due to physician volume mismanagement in 72% of patients - a rate 10% higher than normal.  But more importantly, patient satisfaction scores were perfect in  97.9% of Brian's patients.

A retrospective analysis of the data confirmed the 3.1% failure rate was due to Brian's failure to pick 42 pounds - the desired weight of his anorexic patient - instead of the 43 pounds for her weight that he just eyeballed while also picking non-even, believable numbers to chart for her complete set of vital signs.  For that, she gave him zeros on all his patient satisfaction scores.

After winning the contest and being promoted to Inpatient Manager of Perception, Brian ordered all nurses to manage up their scales by managing down their weight and also anew dress code that included mandatory participation in No-Shave November for all nurses because he thought it would be fun.

*Too Old And Debilitated Syndrome
**little old demented lady




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