Tuesday, April 11, 2023

New! Update for Updated Update: Game Over Updated

Four white dudes doing what they do

I returned to The Ira and VITAS! Show today for the first time since the 6th, and managed to follow along for another four (4!) of the episode's fifty-one (51!) minutes

Here's what I said in the comments this time...

OK so today I could handle about 4 minutes

I got re-oriented with Ira tossing out some nightmare clinical scenarios like bowel infarct, seizures and status epilepticus, though he didn't mention my personal favorite - massive sudden arterial bleed for tumor and tissue damage in head and neck cancer (dark towels?) - to emphasize the need for hospices to provide crisis levels of care (via continuous care in the home or general inpatient care at a licensed staffed facility)

Sure absolutely the IDT has to be prepared for the worst - part of every plan of care should be to ask: what's the worst that could happen? Then make sure to assess monitor prevent and intervene if needed because you were prepared

Now THAT's a great quality indicator

OK, now Ira's jabbering about "kind of have our hair on fire" - kind of? - then goes on to point out the many lost opportunities and failures by the professional orgs (oops) to do anything as it all happened under your nose and under your watch [ref above Christian admitting y'all haven't don't squat about it for 20 years]

I need to be honest with you here: you've been captured, the war is over and VITAS! dude's side won it all

Seriously, consider yourselves captives owned by the financial rapscallions who have taken over hospice, and they're just getting started, so really from here on out your jobs are all about harm reduction and keeping your heads down in order to survive in the current environment

Also too the orgs AAHPM RacistHPNA, of course the trade groups most notably NHPCO and org of orgs NCHPC (Ginger's new gig), etc - they're not just responsible for lots of the problems we're all in, but now also central to whatever "solutions" creep out of this mess or more specifically exploit it

Consider their whacky idea that one indicator of quality should be the number of nurses on staff who are certified CHPN etc via RacistHPNA - which is an excellent idea for RacistHPNA because dues + certification test prep and testing are pretty much the main revenue channels for orgs like RacistHPNA that still follow the model

I'm sure AAHPM is making that same play because orgs are platforms for commerce and careers and that's it

So, to repeat the obvious - you've lost everything at what''s likely the biggest board game most of you have ever played - your battleships are sunk, your king is surrounded etc etc etc

Your jobs are now harm reduction and keeping your head down in order to survive in the current environment

So Lauren has her hair on fire because there's no reason for 1,000 hospices in LA County (Ira says 800 so of course he does), then there's some chuckling about scammers and inside info because VITAS! dude knows where they live

Anyway Lauren asks the burning question - how do we regulate hospice to assure quality BUT! don't make regulations (?)

Or what she's really saying is don't keep dumping everything on the nurses, which is a universal complaint and valid - but seriously Lauren of course rules etc will have lots of implications that need to be figured out and whatever else you want they're not going to be "free," especially the way VITAS! dude's handlers need them to be free or as close to zero as possible, divided by 2

You just negotiated against yourself - you were advocating for something then immediately advocated against it with the other side's own argument

Anyway, Ira droned on and on about three great policy recommendations from some in-group but after he ran out of breath and stopped talking we still have no idea what these great things are in even the most general sense, which at this point we can all just chuckle and say oh Ira... and move on

Eric tosses out another fat slow juicy grapefruit of a pitch to VITAS! dude - hey so I don't suppose you and your bosses like regulations all that much do you? 

And with a mighty swing VITAS! dude smashes a really slow roller down the first base line until it stops at about halfway no he thinks self-regulation is definitely the way to go, then he and Ira fist pump and hug because it's all about quality

Then there's quibbling and second guessing and more negotiating against themselves in an incoherent mess until at one point Eric brings up amyloid eaters the Alz Assoc/pharma scam - and since he's a bright guy of course he sees the connection and the irony of it all before he says let's not bring that up (which was Ira's point a moment ago that the orgs just don't even want to talk about these topics let alone look at them with a critical eye  and basic understanding of financial concepts (making money with money)

Then I stopped watching at about 34:00 - thanks, until next time