Tuesday, April 4, 2023

UPDATED! Updated Game Over Update


Rare shot of Ira with mouth closed

Today I celebrated the halfway point of my journey to listen and annotate the GeriPal podcast video talkapalooza from Montreal - this is not a trip for the fainthearted, especially when it comes to air

It's not that the air gets thinner with altitude - it's the combination of naivety, bullshit, willful ignorance and detached indifference 

Sure, this is a 'professional conference' so the voices of patients and families are notably absent...

Which is the whole freaking problem with the same old models we see here, so as long as y'all keep doing this please don't expect anything different, and none of us should expect y'all to find a way through this mess with the same old models  

You can check out all of my comments at YouTube, here are today's annotations - 

April 4 - OK today I was able to tolerate 2-3 more minutes plus some rewind of Ira's waxing poetic about how great things used to be when the for-profit owners were satisfied with "reasonable" ROI (reasonable to who?) operating "efficiently" (we'll hear that one again) which sounds nice when you're talking about an assembly line but we're talking about patients and families facing serious illness and end of life - oh, wait 

Ira wraps up his monologue with the insistence that "our field has a role to play," and probably means himself more than anything because someone so un-self-aware isn't going to realize it's time to STFD and STFU

Eric steps up again and before you know it launches into an upbeat commercial for VITAS, and the punchline is a physician even cleaned the house! he's never seen another hospice do THAT before!!! 

So Eric there's this role in the IDT called 'hospice aide' where a person goes into the home and provides personal care including light housekeeping and meal preparation if that's part of the individualized plan of care - check it out (warning - irony ahead) 

Anyway after stepping all over what should have been his main question to VITAS dude (what do YOU think of the tension (conflict) between 'excellent hospice care' and 'making lots of money, as much as possible but always more than last time') ...

VITAS dude takes a swing - and there's a slow roller to third, it's not a bunt just really weak contact

Something something Chicago (economics?), then he's in Florida to join a parent facing serious illness

Now he reports to the CEO and is held to metrics so of course he always asks what's best? (for?)

Then he name drops RacistHPNA Board Member Ab '6-Pac' Brody and I'm not sure if he's talking about having or not having an EMR, something about paper and pharmacy and knowing everything and VITAS is great (gonna start writing VITAS!)

Funny story about me and '6-Pac' - he expressed righteous indignation as RacistHPNA BOD member when y'all announced plans to hold in-person in pandemic in freaking Nashville Tenne-freaking-See racist homophobic transphobic Confederate hotbed and thus a risky unsafe place for big swaths of memberships (well, not so big really), and I responded nah - y'all will be there because commerce and careers are more important than caring

How did he respond to that? Let's just say you don't have to be a cishet abled white woman to be a brittle white feminist - in a world of problematic nursing orgs RacistHPNA pretty much heads the list

Anyway VITAS! dude's main point is that his factories are the best - he and Ira high-five chest bump yell 'EFFICIENT!!' - and the only question he asks himself every morning is how many terminally ill people can he help today? HOW MANY?! don't forget he reports to the CEO who reports to the BOD etc

QUANTITY is the only thing that really matters - comps, same store sales - get them to sign on the line that is dotted because even if we have to send a physician over to clean the toilets we'll do whatever it takes, we don't make money on every admission but when you have lots and lots of admissions you can make lots and lots of money

That's the simplest most uncomplicated part of this whole thang

Peace out until next time