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Small Businesses in Illinois Lack Knowledge of What the ACA Has to Offer Them

With Illinois granted early access to the Small Business Health Options Program exchange, or SHOP, small businesses in the state already have the opportunity to familiarize themselves with a new online resource for purchasing health insurance for their employees.

For those that qualify, purchasing health insurance through the SHOP exchange can represent a smart business decision. They can receive tax credits covering up to 50% of their contribution to employee premiums, plus the SHOP allows small businesses to combine their purchasing with other small businesses to keep costs low.

The healthcare law does not require small businesses with fewer than 50 full-time equivalent employees to provide health insurance. Because 94% of businesses in Illinois employ fewer than 50 people, a large majority are exempt from offering health insurance.

The SHOP was meant to minimize the number of people left out of health reform by helping small businesses provide health insurance anyway, with tax credits and collaborative purchasing power incentivizing this option by keeping costs lower.

But to what extent are small businesses taking advantage of the SHOP? Health & Disability Advocates and Crain’s Chicago Business teamed up to find out and conducted a survey of small business owners. The results are documented in a recently released report from Health & Disability Advocates and an article in Crain's Chicago Business.

The survey found that small businesses are not using the SHOP to purchase health insurance and are largely uninformed about it:

  • Fewer than 18% of small business owners said they had learned “a lot” or a “a great deal” about the SHOP.
  • Only 11% took advantage of the small business healthcare tax credit.
  • And finally, 31% of small businesses surveyed said they did not know whether they were receiving the small business healthcare tax credit.

These findings mirror national trends. In a national survey by the National Small Business Association, 8% of small business owners reported they would use the SHOP to buy health insurance. Similar figures from the Kaiser Family Foundation were cited in a recent blog post at The New York Times.

Small businesses would gain from outreach and education on benefits of the SHOP and how to use this resource. Informing the business owners about the SHOP would equip them with information that they could use to enroll their employees in health insurance, an important benefit that helps in retaining and attracting workers.

Since small businesses overwhelmingly rely on brokers when purchasing insurance, the broker community could be a resource in outreach and education efforts. Indeed, brokers are increasingly viewed as vital partners in healthcare outreach and enrollment efforts. For example, during the first enrollment period they played a key role in the famously successful effort in Kentucky. Partnering with brokers to conduct outreach can help increase the numbers of small businesses that offer health insurance – and the number of individuals enrolled in healthcare.

The bottom line is that small businesses in Illinois are not aware of the Small Business Health Options Program, the tax credits available to them, or other ACA provisions that could benefit them. For us to effectively reach these important job creators and help them take advantage of these provisions, we must engage the broker community to provide this new outreach and education to their existing clients.

Bryce Marable, MSW
Policy Analyst
Health & Disability Advocates

Rural Doctor Fired for Not Waving Back to Local Residents in Public.

Abigail, KS --  Brown Community Hospital fired their only Family Medicine physician on Wednesday after town residents complained he never reciprocated the two finger greeting in public. With great fanfare, Dr. Riley Jones had just been hired two months prior after the critical access hospital failed to sign a local physician for the previous three years.

"The CEO welcomed me into in his office with a two-finger-hat-tilt-head-bob-wave and then told me to clean out my desk," said Dr. Jones, who was shocked a hospital would fire the only doctor within 60 miles for failing to wave back in public.

According to hospital officials, Dr. Jones was contractually required to initiate a wave or to wave back to town members as a sign of community respect.

"On numerous occasions, we asked the doctor to participate in our class on How to Improve Patient Satisfaction through Public Hand Waving, but he never complied.  His repeated lack of respect for community standards left us no choice but to let him go," said CEO Benny Brainard, known for his right-hand-index-finger-circular-lift-off-the steering-wheel-wave when leaving the hospital in his 2001 Buick Regal.

"I've never been to a small town before.  In Kansas City, waving at strangers will get you shot," said Dr. Jones, who has already found another job in a lucrative cash only Kansas City botox clinic for three times the money.

Several years ago, Medicare started paying hospitals based on patient satisfaction scores. Since then, hospitals have placed increasing pressure on physicians to keep patients happy at all costs.  A 2013 Gallup survey found rural hospitals could increase their patient satisfaction scores by 28% if physicians facilitated or reciprocated  a friendly wave to community residents in public.

 Dr. Jones was the target of animosity even before he saw his first patient.   "He didn't even acknowledge me when I drove past him at church," said, Annabelle Vedlaceck, one of several elderly ladies who started organizing the doctor's recall just days after his arrival.  "I think it's rude not to get  the finger from your doctor," said Annabelle, as she greeted the hospital's on-call night nurse, passing by on a bicycle, with a two-finger-chin-bob-left-eye-squint-wave.

Finishing first in his medical school class and saving  the life of two local residents after just a week on the job was not enough to overcome dissatisfaction with his lack of hospitality.  Multiple town residents met with hospital officials at Bill's Cafe in September to demand Dr. Jones be fired or they would boycott the hospital and travel 60 miles out of their way to Green Community Hospital, where their doctor always gives a friendly left-handed-two-finger-brow-touching acknowledgement to the lay folk.

Outsiders may question the utility of firing the town's only doctor they've had in years for presumed rudeness, but local residents disagree.  "The one-finger wave is such a basic part of our community, we just can't let it slide," said John Banner, a farmer who lost all but a single waving finger in a combine accident at the age of 12.

"Getting a one-finger-wave from my doctor is the best medicine I could ever ask for."



Top 10 List of Social Admits Defined!

What is a social admit to the hospital?   A social admission is generally accepted by healthcare professionals to be a patient with no acute medical needs that is brought into a hospital because no safe discharge arrangements could be made at the time they presented.

Most social admits involve elderly patients who present to an emergency room with weakness, have a thorough negative workup and are too weak to go home but have no where else to go. They might have a non surgical fracture limiting their mobility or a family refusing to take them home.

Most social admissions occur after-hours when community services are unavailable to assist with a safe discharge.  Most patients are admitted through the ER by a Hospitalist to observation status, which often causes the patient to be readmitted a month later with a stroke or a heart attack when they get a bill for thousands of dollars in uncovered Medicare services.

Most of the time, a social admit can be safely discharged within the next 48 hours, which happens to be the time Medicare will pay for observation status.  Occasionally, a weekend or a holiday throws a wrench in the plan and hospitals become default nursing homes until discharge can be arranged.

On rare occasion, social admits stay weeks, sometimes months, in a hospital because no long term care facility will accept them.  Some patients, and their families in particular, have burned all the bridges in their community nursing homes and patients have no where to go.  Occasionally patients are too dangerous for nursing home care and state psychiatric wards refuse to accept them because of other chronic medical needs they can't provide for.

Every now and then hospital medical teams ask adult protective services to start revocation proceedings to strip powers of attorney rights from families of patients they feel are neglected from failure to place into long term care.

What is the longest hospital stay ever?   That's a good question readers could shed some light on. Feel free to leave a comment with the longest hospital stay you've ever heard of.  This AHRQ graph presented here shows the two most common longest hospital stays are pediatric related with premature birth and infant respiratory distress syndrome.  However, neither comes  close social admit lore.  Some patients have reportedly spent months or years in a hospital waiting for discharge.

Readers have previously shed some light on the definition of a social admit (admit to the hospital to arrange for a nursing home placement) and the social admit marathon (when the admission and arrangement for placement happens twice a month for 3 years).  Make sure to update your vocabulary with all the funny medical slang.

What does the Top 10 List of Social Admits look like?  The Happy Hospitalist Facebook asked readers to help define The Social Admit and they didn't disappoint.   Here is the list of the top 10 social admits based on comment likes.
  1. Nobody, and I mean nobody,  wants to do incontinent grandma's colonoscopy bowel prep at home.
  2. I once worked for a cardiologist who was asked to admit an older physician's mom because her home was being painted.
  3. Family took mom off hospice and brought her in for the holidays so they could go out of town for Christmas and New Years.
  4. The family has been caring for grandma at home for a number of years but have suddenly decided on a Friday night at around 9 pm that they can no longer handle it.
  5. Once had a dead patient left in a wheelchair by family.
  6. "My mom hasn't been acting themselves (they are 80+yrs old) I think something is wrong" followed by "If you need to get ahold of us here is our cell number we will be down in the Caribbean for an already planned vacation" as they run out of the hospital leaving a smoke trail.
  7. Wife admitted with pneumonia.  She brought in alcoholic spouse because he was "unsafe at home without me."  He was admitted after wandering around the ER's seclusion area.  They had rooms down the hall from each other, but the man didn't want to allow her to see him because he was mad at her for bringing him in. Nicest drunk I've ever cared for.
  8. Patient was admitted for possible spider bite on arm. Patient only needed high doses of intravenous pain medication and cable TV because WWE was on.  Patient and family didn't have cable at home and the hospital was within walking distance for everyone.
  9. Caregiver no-showed and we couldn't get a SNF admit.  You know you can find a "UTI" or "pneumonia" on pretty much anyone!  Solid goto diagnosis for those social admits.
  10. I have had many a patient show up in the ER with suitcase in hand because they are just going to be admitted no matter what.

Here is the rest of the social admit list compiled by Facebook readers.  If you haven't joined, make sure to like the page and never miss another status update again.  You won't find this kind of important information anywhere else!
  • The family is going out of town for a state Basketball tournament and couldn't take grandma.
  • Long term dementia patient but the family swears there are new mental status changes, increased confusion.  Come on.  And the million dollar work up begins.
  • Altered mental status in Alzheimer's patient on a holiday weekend.
  • I had a patient admitted for "dementia".  When I called the hospitalist to notify him of her admission and arrival to the floor he asked what she was admitted for. I said "dementia." He said, "Is that even a diagnosis for admission?" I said listen, "She has dementia and the husband takes care of her but he was admitted for pneumonia and the family doesn't know what to do with her so they wanted to check her in too." So, apparently dementia is in fact an admission diagnosis.
  • When my great-grandmother had each of her (nine) kids, she stayed in the hospital with the newest baby for 6 weeks in a private room with her own private duty nurse. It's like the complete inverse of social admits now... Instead of being pawned off by a family not willing/able to provide care she was getting away from being the caregiver, and they just paid for it with no middle entity like you did back then. Back to today, my favorite is the social failure-to-discharge: when you discharge a patient yet they're still on your list the next day, and the next, and the next, just because of social/placement issues.
  • The VA.
  • Bringing grandma in so family could evacuate for hurricane.
  • My favorite is the demented John Doe dropped off at the ER entrance with no admission reason but no ID or contact info either. Thanks family.
  • "Confusion" at 3 a.m. after taking sleeping pills, from the Alzheimers/Dementia unit.  Baseline neuro: confusion.
  • Patient flown in from remote Alaska location for "skin infection" but discovered to be homeless, broke, and has a blister from 5 days of walking around without changing his socks or shoes after he spent time up to his knees in mud.
  • Family didn't want to take grandma on vacation with them.  Decided 90 year old grandma needed admission for ETOH detox.
  • Bringing grandma in so family could go on a cruise.
  • Grandma is demented and family was remodeling the house, thus rendering it an unsafe environment for her.
  • And don't leave out the extended stays! Grandma is ready to discharge Friday but the family can't pick her up until Monday because they're "out of town."
  • Friday night ER visit: loving son drops off demented mom for confusion but can't be reached until Monday because coincidentally he is out of town for a wedding and demands her discharge Monday morning at 0800.
  • 300+lb middle-aged female that "can't" walk (i.e. wont walk) and has urinary retention, has "servants" that help her in the home but family refused to take her back home with a foley leg bag despite extensive teaching of both patient and family.
  • How about admission for possible seizures because it was the middle of winter, snowing and the person was homeless.
  • Family brought grandma in because "it was time for that free nursing home" but demand the really nice one 'cause only the best when it's free!
  • Patient arrives from another country yesterday to stay with family but family quickly realizes they can't care for them. Patient receives dialysis but treatment hasn't been arranged and patient's insurance doesn't carry to the U.S!
  • Nursing home drop offs for weekends and holidays for "altered mental status" that have been going on for a week.
  • I was working at LA County Main admitting one night when a guy came in because he had been evicted at 11 o'clock at night. He knew there was a social worker there at night.
  • It's Saturday night and family wants to party, so they drop off the patient in the ED with a suitcase full of clothes and say they'll pick her up on Monday.
  • Currently trying to deal with a chronic lunger who wants to stay because they turned off her electricity. Still has enough cash to buy cigarettes though. Oh yeah, I do have to feed her too. Glad to see my tax money going to a good cause.
  • Most of the referrals to acute rehab are for social reasons. We are not your grandma's babysitters. * sigh*
  • When I worked during Hurricane Katrina, we had multiple admits from home because the family didn't want to take their loved ones with them, or they were on home oxygen. Extreme case, but true. Needless to say, our wall oxygen didn't work, we had no running water or electricity, and they were medivac'd out to God knows where.
  • Wealthy family in a small town has family come to visit.  Elderly aunt has a personal care giver with her but dear aunty is admitted to hospital for "HOSPITALITY" level of care! Out to family gatherings during the day but was brought back by 7 pm, put to bed by care giver who then went back to enjoy socializing with the family... the hospital tied up a 2 bed room in a critical access hospital for $10/night! We pottied her, changed her bed etc & were told to cater to her. We had to remind ourselves frequently that if you have the right name & position in the community you can get this service. No one else EVER got "HOSPITALITY " care.
  • Chicago. Old couple admitted because their heater broke last winter.
  • Had an ER patient brought by ambulance from another hospital ER because the wait was too long.
  • Daughter just can't do the dressing changes anymore (had home health for six days a week for a little foot wound) she had to do the dressing once a week (or could have let it go one day)
  • Constipated severely demented 98 year old whose wife couldn't get him to take laxatives (and would probably have broken both their hips getting to the bathroom if he had taken them).
  • Parents bring in child on medicaid for running fever all week on Friday night to ER. Leave and come back to take home Sunday afternoon. Can't call it neglect because they left in care of responsible people! Parents get free babysitter for weekend.
  • Brother and sister admitted for varicella because the family had plans to go to a water park for the weekend.
  • Because family planned a vacation and forgot to find someone to watch grandma.
  • Kicked out of assisted living home because of behaviors on continusou oxygen and 22% lung function with severe COPD.  Social worker drops him off at ER for "SOB".  No where to discharge to! Spent a week admitted walking halls and flirting, room service while someone found him a place to go!!
  • I thought you were referring to the patient using the phone the entire time with a room filled with company and relatives calling for an update q15m (every last one of them drunk and hungry). After all, the patient does need the sliver removed. My duh. I had to read the other posts. Gotcha.
  • 89 year-old grandma with Alzheimer's brought in by local fire rescue. She was found wandering in her night gown. Police got her address off of a ID necklace she was wearing. When they got to her house they found her husband dead. During the middle of the night he had passed from a massive MI and no one was around to take care of her.
  • Husband has been taking care of wife at home, who has advanced multiple sclerosis for 10+ years. Apparently no followup, no therapy, no home care. Decides on Monday that since he's having back surgery on Thursday, he can't care for her. (Sad thing is, she went skilled and will probably never go back home. She's 56.) Sad social admit, because she had no acute illness, but so preventable.
  • Why is it always grandma and never grandpa
    • Editor:  Good point!
"Ask your hospitalist today if mom is too old to hyperventilate and they'll work the system to get her free entry into the Nursing Home Marathon paid for by Medicare"

Ask your hospitalist today if mom is too old to hyperventilate and they'll work the system to get her a free entry into the Nursing Home Marathon paid for by Medicare ecard humor photo.


"Did you know 'too angry for discharge' and 'patient refuses to leave the ER' are now Medicare approved reasons for inpatient admission?"


Did you know 'too angry for discharge' and 'patient refuses to leave the ER' are now Medicare approved reasons for inpatient admission doctor ecard humor photo.


"Prepare yourself! Holiday admits are coming!"

Prepare Yourself. Holiday Admits are Coming medical humor meme photo.




Hospital Bans Unauthorized Nurse Bathroom Breaks

Albuquerque, NM -- Pine View Hospital on Friday started banning unauthorized nurse bathroom breaks, cutting cost in anticipation of reduced payments next year.  Officials believe the move will allow 32 projected nurse retirement positions to go unfilled and save the hospital several million dollars.

"Thirty-five years ago, I remember taking at least 8-10 bathroom breaks a day.  Now, I'm lucky if I get one,"  said Sandy Berrymore, an outpatient surgery nurse who made sure to tell everyone around her she was just 78 days away from retirement.

Starting last week, Pine View Hospital started authorizing nurse bathroom breaks with a daily first-come, first served sign up sheet posted outside the staff bathroom area at change-of-shift, to encourage nurses to get their business done before their shift starts.

Hospital officials say they were prepared for long lines starting several hours before clock in.  "We installed two additional porta-potties near the staff break room on each floor to make the process as least disruptive as possible," said CEO Jake Fedmore, who was given an 8% raise next year for this creative idea.

Less than a week since the new policy began, nurse productivity has increased by 30% and two million dollars in costs savings are projected annually.

"I can't believe how much money I'm saving my hospital by foregoing my bathroom breaks,"  said new nursing graduate Theresa Beddle, who was trained to take one for the team whenever a challenge arises.

The policy does provide medical exemptions if a notarized physician explanation is provided.  "I had a charge nurse barge into the bathroom yesterday telling me I was not authorized to poo, until I showed her my doctor's note," said Jenny Allingsworth, a nurse who's doctor authorized 10 breaks a day.

To help prepare nurses for their new expectation, Pine View Hospital is encouraging nurses to view their free online classes, including Methods to Hold Your Bladder after CPR,  How to Work 12 Hours without Drinking and Mind over Bladder.

Based on the overwhelmingly positive economic impact in just the first week, CEO Jake Fedmore plans to take the policy to the next level with a more aggressive algorithm (Figure 1) next year.  "I'm anticipating at least a 15% raise next year with this awesome idea."

"Nurse Bathroom Break Protocol"

Nurse Bathroom Break Protocol Algorithm Humor
Figure 1:  Nurse Bathroom Break Protocol


This funny nurse algorithm is available for purchase on t-shirts, mugs, and holiday ornaments and other gifts from The Happy Hospitalist Zazzle store.  Huge discounts (up to 60% and more) are available for Veterans Day Sale using discount code VETERANDAY14.



Democratic Donkey Taken to ER After Near Drowning by GOP Tidal Wave.

Washington, D.C.  --  The Democratic donkey was taken to the emergency room in critical condition Tuesday after the beloved mascot nearly drowned during an election night GOP tidal wave that ripped across America.  The heroic actions of  two off duty Hospitalists and a nurse were credited with stabilizing the national icon before ambulance crews arrived to transport the donkey to the nearest hospital.

"We take care of a lot of jackasses just looking for a hot and a cot in the hospital, but we knew immediately this guy was in trouble.  We wanted to start CPR but realized we didn't have any nurses to guide us, that is until one showed up at the last moment to tell us what to do." said Dr. James Fedora, the Hospitalist who always shows up last to CPR.

The Democratic icon was nearly turned away from the hospital after ER doctors weren't sure if treating donkeys was within their scope of medical practice, but that fleeting thought quickly turned to action when they realized  the donkey was a jackass and he had EMTALA on his side.

"EMTALA delivers me jackasses everyday.  This day was no different so we sprung into action,"   said Dr Jenny Banner, the ER doctor who speaks for all ER doctors everywhere.

Rep. Debbie Wasserman Schultz, Democratic National Committee Chair, was thankful for the heroic actions of medical bystanders,  but quickly became agitated after she learned the hospital where the mascot was sent does not accept the pet insurance plan her committee purchased through the Washington, D.C. Health Benefit Exchange Authority.

"I was told our mascot's bills would be out of network.  That's unacceptable.  Starting tomorrow, I'm going to ask President Obama to sign a declaration requiring all hospitals to accept pet insurance."

News of the mascots critical condition quickly made it to social media sites.  Democrats filled Facebook, Twitter and blog comments blaming Republicans for their tidal wave, calling them bad names and accusing them of being intolerant for not agreeing to have only  the views they approve of.



"I Don't Know My Body" Patient Creates Havoc In Local ER.

Fort Collins, CO --  Doctors and nurses at St. Mary's Hospital were on edge yesterday after 27 year-old teenager Jenny Franklin ran straight through ER triage repeatedly yelling "I don't know my body!" as her mother smother, with two suitcases in tow, hovered over her every word.

"In my 27 years of nursing, I've never had an anxious young female  tell me they didn't know their body.  Quite frankly, I was scared for her," said Janice Jurgensen, the ER nurse assigned to stabilize Jenny and her mother as payback for calling in sick three Friday nights in a row.  "We've had drills to prepare us for this day, but I never thought we'd see it in our ER."

After everything comes back normal, young females are known, on occasion, to get angry at ER doctors and nurses when they are told nothing is wrong with them.

"Most of the time it's just anxiety, but Press Ganey prevents me from diagnosing that in the ER.  So I'm forced to look really baffled when I tell patients I have no idea what's going on," said Dr. Bill Heraton, the ER doctor with expertise in keeping a straight face while laughing deep inside.  "After I tell them their primary care doctor has lots of time to continue the work up in their office, they usually leave with a smile."

Emergency physicians are trained to identify red flags, findings that always require further workup, including Jenny's case, which had three obvious red flags.  "When a young woman walks in saying, 'I don't know my body!' with a frantic mother carrying two check-in sized suitcases, you must respect that," said Dr. Heraton, who recommended moving the patient immediately out of his emergency room to be stabilized in the ICU because a similar woman he discharged to home during residency ended up being literally smothered to death by her mother's hovering.

Doctors worried as female claims, "I don't know my body."
Shortly after informing Jenny of her ICU admission, Dr. Heraton was forced to intubate after nurses couldn't get her to stop breathing slower than 70 times a minute, despite music therapy, pet therapy,  a lavender plant and the comforting shoulder touch of a compassionate ER nurse.  "I knew she needed tubed the moment I lay my eyes on her," said Dr. Heraton, who got perfect satisfaction scores for his great call that day.  "The ICU is the only place they can monitor the mother 24 hours a day."

Jenny's mother was thankful for her transfer to the ICU even though all ER studies came back normal and no further work up was planned by the hospitalist.   "I know Jenny's body better than anyone and we're not leaving the ICU until somebody gives me an answer about why she doesn't know her body," said Jenny's mother, who also requested a king sized cot, a full size dresser and a Keurig be provided for her own stay in the ICU.



Man with Frequent CHF Readmissions Found To Be Half Sponge.

Birmingham, AL --  With seventeen readmissions for congestive heart failure in the last year, 58 year-old Kevin Spencer finally got the answer he was looking for.  Doctors at Baptist Hospital diagnosed him as being half sponge after ruling out all possible explanations for his recurrent CHF exacerbations.

Congestive heart failure is a leading cause of hospitalization in the United States.   Hospitals risk losing millions of dollars through complicated formulas when CHF patients are readmitted within 30 days of discharge.  To reduce the risk of Medicare penalties, Baptist hospital re-engineered their hospital discharge last year, but Kevin kept coming back.

"We tried everything to keep Mr. Spencer out of the hospital, but nothing worked," said Dr.  Jason Harvey, a hospitalist who has copied and pasted at least four of his H&Ps.

"The last time I discharged Kevin, I wrote orders that planned out his life for him, right down to the last minute to try and prevent him from getting readmitted and look where all that time and effort got us."

The sponge diagnosis, reported in the New England Journal of Medicine last month, was stumbled upon by a third year medical student who quipped the possibility while being pimped on the causes of CHF exacerbations during morning report.

CHFer found to be half sponge
"Everyone laughed at first, but then we all thought he was brilliant.  We ordered a stat skin punch biopsy on a Friday evening and we were all shocked when testing confirmed he was half kitchen sponge," said Dr Harvey, who has since implemented a sponge analysis protocol for all heart failure patients at his hospital.

For Kevin, the diagnosis makes perfect sense.   "I kept telling them I don't eat anything with salt and they kept shaking their heads and rolling their eyes at me.  I plan to move somewhere dry because they tell me I'll just keep absorbing humidity through my skin if I stay in Alabama."

"We told Kevin his only chance at a normal life outside the hospital was to get as far away from Birmingham as possible, preferably a desert community in the Southwest," said Dr Harvey, who was happy to learn he will earn a $1,000 readmission avoidance commission from his hospital once Mr. Spencer's move is confirmed.

In addition to Half Sponge, physicians at Baptist Hospital have also discovered most of their readmissions are either Half Dead or give a Half Assed attempt to stay out of the hospital.

"Discharged CHF. Didn't return for 31 days!"

Discharged CHF. Didn't Return for 31 days humor meme.



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