Saturday, February 09, 2008

Sunday Funnies

An eye doctor, a heart surgeon and an HMO executive die and go to heaven.

God asks the eye doctor why he should be let into heaven, and the doctor explains to God that he helped people save or regain their sight. God says, ''Welcome to heaven, my son.''

God then asks the heart surgeon what he had done in life that should allow him into heaven. ''I saved people from death from heart attacks and heart disease,'' the doctor replies. ''Welcome to heaven, my son,'' God says.

God then turns to the HMO executive. God asked him what he was, and the man replied that he worked for an HMO. ''Welcome to heaven, my son,'' says God, ''but you have to leave in two days.''


Blogger Ramblings of a Villas Girl said...

Good one Ralph. I look forward to your "Sunday Funnies". It is nice to start the week with a laugh.

Regarding you previous post. I am the Recording Secretary for our municipal Planning & Zoning Boards. Luckily our meetings don't go six hours, but some have come close. With those meetings everyone is just rambling on and not making sense. This is where I start losing patience and lean over to my boss and tell him to get this meeting back on track. I have better things to do then sit here because this is their night out away from their better half. I completely understand about the "certain body parts" and will usually say it is time for a bathroom break to try and get the blood flowing again. Like your recording secretary, I usually will write the same statement if a disagreement starts, it is past my bedtime or I'm just plain bored.

Well rambled enough. Again thanks for the laugh and have a good weekend.

6:21 AM  
Blogger Cliff said...

Good one Ralph.
Semi private room at that I presume.

6:45 AM  
Blogger bobbie said...

Yes, another good one, Ralph. And I'll bed there were people from Medicare in line behind the HMO exec.

7:52 AM  
Blogger bobbie said...

Sorry, I meant "I'll bet".

7:53 AM  
Blogger Janell said...

Another good one. I love your Sunday funnies.

3:38 PM  
Blogger Jim said...

Hi Ralph. That is a good one.

Medicare is much like the HMO, they have a 'DRG' stay length and payment quota per patient based on diagnosis. When that stay is exceeded, the hospital has to eat the rest.
Needless to say, Medicare patients are shuttled to the nursing homes when they run out of DRG's.
I think HMO, Medicare, and socialized medicine all belong to the same species.

4:29 PM  
Blogger Jim said...

Ralph: You and others who work for government agencies will understand this. It contains DRG information.

Medicare Prospective Payment System
The Medicare Prospective Payment System (PPS) was introduced by the federal government in October, 1983, as a way to change hospital behavior through financial incentives that encourage more cost-efficient management of medical care. Under PPS, hospitals are paid a pre-determined rate for each Medicare admission. Each patient is classified into a Diagnosis Related Group (DRG) on the basis of clinical information. Except for certain patients with exceptionally high costs (called outliers), the hospital is paid a flat rate for the DRG, regardless of the actual services provided.
Each Medicare patient is classified into a Diagnosis Related Group (DRG) according to information from the Medical Record that appears on the bill:

Principal Diagnosis (why the patient was admitted)
Complications and Comorbidities (CCs - other secondary diagnoses)
Surgical Procedures
Discharge Disposition (routine, transferred, or expired)
How it Works
Diagnoses and procedures must be documented by the attending physician in the patient?s medical record. They are then coded by hospital personnel using ICD-9-CM nomenclature. This is a numerical coding scheme of over 13,000 diagnoses and 5,000 procedures.

The coding process is extremely important since it essentially determines what DRG will be assigned for a patient. Coding an incorrect principal diagnosis or failing to code a significant secondary diagnosis can dramatically effect reimbursement.

There are over 490 DRG categories defined by the Centers for Medicare and Medicaid Services (CMS, formerly known as HCFA). Each category is designed to be "clinically coherent." In other words, all patients assigned to a DRG are deemed to have a similar clinical condition. The Prospective Payment System is based on paying the average cost for treating patients in the same DRG.

Each year CMS makes technical adjustments to the DRG classification system that incorporate new technologies (e.g. laparoscopic procedures) and refine its use as a payment methodology. CMS also initiates changes to the ICD-9-CM coding scheme. The DRG assignment process is computerized in a program called the grouper that is used by hospitals and fiscal intermediaries.

Each year CMS also assigns a relative weight to each DRG. These weights indicate the relative costs for treating patients during the prior year. The national average charge for each DRG is compared to the overall average. This ratio is published annually in the Federal Register for each DRG. A DRG with a weight of 2.0000 means that charges were historically twice the average; a DRG with a weight of 0.5000 was half the average.

4:32 PM  
Blogger Rachel said...

Good one Ralph!! What goes around comes around, right??

5:34 PM  
Blogger Cathy said...

I just LOVE your Sunday funnies. A good laugh any day of the week! Thank you!

9:41 PM  

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