(no subject)
Lordy, how the time does pass. If I'm to get a post in for February, though, this would be the time.
I took a snow day today. Although not technically blizzard conditions, we've had pretty heavy snow and wind for the last 12 hours (about 2"/hour with 20 mph winds at the peak). I did put in a good effort this morning: got up at 4:30, showered, shoveled our car park, battled my way out of the condo lot at 6:30, and got about 5 miles from home. There's a big hill on the state road I take to work, though, and by the time I got there (nearly an hour after leaving the house) there were 20 cars spun out, blocking the whole road at various intervals. I'd have taken a picture, but I was pretty busy safely making a U-turn and getting the heck out of the way before any of them slid any further downhill. When I got home around 8:00 there was no evidence at all that I'd shoveled or made a dozen attempts at getting out of the driveway.
The part about my job that's equally convenient and frustrating is that I work under Medicare/Medicaid laws. That means if I write in my treatment plan that I'm going to see a patient 5x/week, they MUST be seen five times. Must. No two ways about it, barring major emergencies (and even then the building can be cited for being out of compliance). The reason has a lot to do with the B.S. way that Medicare pays for therapy, which is based on "should do" rather than "actually do." There's further breakdown and differences in how the "should do" is determined. In other words, the building is paid for services that are expected to be rendered (based either on # of visits per week or # of minutes of service) rather than on what actually happens. For example, Medicare A looks at a window of 5-14 days and bases their reimbursement on that - which means many of the shadier rehab managers coerce therapists into giving way more therapy during that window than the patient can actually tolerate or beyond what they realistically need. Medicare B looks at the number of visits per week and the type of therapy being given, then they pay a flat rate based on that. This can be frustrating because on days like today, when I can't get to work, I've got to go in on a Saturday to make up the time.
(Medicaid, on the other hand, is for poor people rather than for seniors, so they're "worth" a lot less in terms of reimbursement. Many places won't take Medicaid patients for precisely that reason. Not to mention how much stuff Medicaid refuses to pay for, and since Medicaid patients in nursing homes have literally no money of their own then the facility ends up footing the bill.)
On the other hand, so long as a person is seen for a minimum of 15 minutes it counts as a "visit," regardless of the time of day (assuming I do actual skilled treatment - I can't just go in and chit-chat or watch them sleep for 15 minutes). So if I need to, I can take off an hour or two in the middle of the day. I don't do this, but for some therapists who need to pick up their kids at school or go to appointments it's very handy.
Why all this hum-drum talk about work? Probably because I feel so guilty for calling out even though I can "make up" my work tomorrow. It makes me uneasy that I'm sitting at home when I should be Doing Stuff.
ANYWAY, maybe I'll go clean the floors and make banana bread. Might as well make the most of my day.
I took a snow day today. Although not technically blizzard conditions, we've had pretty heavy snow and wind for the last 12 hours (about 2"/hour with 20 mph winds at the peak). I did put in a good effort this morning: got up at 4:30, showered, shoveled our car park, battled my way out of the condo lot at 6:30, and got about 5 miles from home. There's a big hill on the state road I take to work, though, and by the time I got there (nearly an hour after leaving the house) there were 20 cars spun out, blocking the whole road at various intervals. I'd have taken a picture, but I was pretty busy safely making a U-turn and getting the heck out of the way before any of them slid any further downhill. When I got home around 8:00 there was no evidence at all that I'd shoveled or made a dozen attempts at getting out of the driveway.
The part about my job that's equally convenient and frustrating is that I work under Medicare/Medicaid laws. That means if I write in my treatment plan that I'm going to see a patient 5x/week, they MUST be seen five times. Must. No two ways about it, barring major emergencies (and even then the building can be cited for being out of compliance). The reason has a lot to do with the B.S. way that Medicare pays for therapy, which is based on "should do" rather than "actually do." There's further breakdown and differences in how the "should do" is determined. In other words, the building is paid for services that are expected to be rendered (based either on # of visits per week or # of minutes of service) rather than on what actually happens. For example, Medicare A looks at a window of 5-14 days and bases their reimbursement on that - which means many of the shadier rehab managers coerce therapists into giving way more therapy during that window than the patient can actually tolerate or beyond what they realistically need. Medicare B looks at the number of visits per week and the type of therapy being given, then they pay a flat rate based on that. This can be frustrating because on days like today, when I can't get to work, I've got to go in on a Saturday to make up the time.
(Medicaid, on the other hand, is for poor people rather than for seniors, so they're "worth" a lot less in terms of reimbursement. Many places won't take Medicaid patients for precisely that reason. Not to mention how much stuff Medicaid refuses to pay for, and since Medicaid patients in nursing homes have literally no money of their own then the facility ends up footing the bill.)
On the other hand, so long as a person is seen for a minimum of 15 minutes it counts as a "visit," regardless of the time of day (assuming I do actual skilled treatment - I can't just go in and chit-chat or watch them sleep for 15 minutes). So if I need to, I can take off an hour or two in the middle of the day. I don't do this, but for some therapists who need to pick up their kids at school or go to appointments it's very handy.
Why all this hum-drum talk about work? Probably because I feel so guilty for calling out even though I can "make up" my work tomorrow. It makes me uneasy that I'm sitting at home when I should be Doing Stuff.
ANYWAY, maybe I'll go clean the floors and make banana bread. Might as well make the most of my day.