Monday, April 29, 2013

Getting ready to leave again!

Getting ready to leave again!
Well the time at home has been great and I have accomplished a lot around the house. The “hunny do list” is much shorter than it was when I got home in February. I have had a few dates with my wife, went on a week-long family cruise over spring break, and got to watch my son shoot trap every week. I have finished the fence in the back yard for the girls (that would be female dogs) so they won’t have to be walked. The lawn mower has sharp blades and the grass has been cut (several times).
Since this is going to be an extended trip (5 months), the family will be there visiting for several weeks, and salmon season opens in May, I am shipping some things to Dillingham. I have found out that the least expensive way to ship is via USPS parcel post. The drawback is that it will take about two weeks to get there. I have those boxes packed and will drop them off at the Post Office on my way to the airport Wednesday morning.
My “plan” was to pack my bags today, BUT yesterday afternoon I noticed the house was awful warm. When I checked the AC unit, the start capacitor (thingy that makes it run) had been destroyed by a voltage surge during a thunderstorm the night before. So I spent the morning driving to the other side of Memphis to get the part to fix the unit. So my AC repair went something like: 15 minutes to diagnose, 4 ½ hours running down the part, and 15 minutes to do the repair. Needless to say, I did not pack today.
So tomorrow I pack and plant blueberry bushes. Wednesday will be spent flying from Memphis to Anchorage then Thursday on to Dillingham. Of course it is supposed to snow 1-3 inches Thursday in Dillingham, lucky me. My next blog will be about what I find when I get back to Dillingham.
Have a great week!

Thursday, April 25, 2013

What I think of Dickies EDS Scrub Tops

Just like most of you, I have worn scrubs almost every day for many years. What I look for in scrubs is comfort and durability. When I travel to an assignment, I am limited in what will fit into my suitcase. That means if I am on an extended assignment, my scrubs get washed frequently. They must hold their color after repeated washings and be made of a durable fabric.
I have been asked by Uniformed Scrubs to do a product review of their new line of Dickies scrub tops. When I got the email asking me if I would be interested in doing a review, automatically red flags went up. I responded to the email inquiring as to the companies “expectations” of my review. Ralph had already envisioned them expecting me to write a glowing rant about their product.
Usually the companies want final approval of what will be posted. I do not blog for anyone’s benefit but mine and I will not be bought or “bribed”. The response I received was definitely a pleasant surprise, and I quote: “We would be happy to get your honest opinion and have your review posted on the blog for your followers”. This led me to believe that they were confident in their product and I would be satisfied with my evaluation.
I received a navy blue Dickies EDS (Every Day Scrubs) Men’s scrub top by Priority Mail. When I opened the package I found, what appeared to be, a well-made scrub top. The size I requested is the “normal” size I wear; when I tried it on I found it roomy and comfortable. I was pleasantly surprised to find the left front pocket is actually two pockets, one over the other. The back pocket is full size and has a pen sleeve. The front pocket overlays the back pocket and its opening is about one inch below the back pocket. Then came the real test, since it is navy blue how will the color hold up. Well I am pleased to say after ten washings, it is just as blue as the day I got it.
So for this product I definitely have a positive review. The scrub top is well made and well worth the cost. Below is the “official” description of the top and a link to the Uniformed Scrubs catalog:

Dickies Men's Raglan Sleeve Scrub Top in 15 Colors
Style 816106
Men's Fit V-neck features raglan sleeves and layered chest pocket. Back length: 29".

Brand: Dickies
Collection: EDS Fit for Men
 Fabric: Poly/Cotton,Poplin
Detail: 65 % POLYESTER/POLIESTER-35% COTTON/ALGODON
 Gender: Men's
Neckline: V-neck
Sleeve: Short
 Body Type: Contrast Raglan Slv
Top Pockets: Chest

Monday, April 15, 2013

Heart of America Medical Center



Heart of America Medical Center
Rugby, ND
This past weekend I have been at HAMC in Rugby, ND. When I work at this facility, I cover the ER, a 20 bed Acute unit, and an attached 80 bed skilled nursing facility. I have worked here in a locum’s status since 2012. To get here, I fly to Minot, ND from Memphis on Friday morning and “usually” fly home from Minot on Monday afternoon.
This weekend is a little different, due to the “severe winter storm” last night and this morning, my relief could not get here. Besides that, the 80 miles of road between Rugby and Minot were iced over. Needless to say I am still in Rugby. I have cancelled today’s flight and hopefully will be able to get home tomorrow (Tuesday).
Since many of you ask about the facilities I work in, I will tell you about the facility and a little about Rugby which just happened to be the geographical center of North America.
Heart of America Medical Center
History
Good Samaritan Hospital Association was founded by farsighted, pioneer Lutheran pastors dedicated to community service. This sense of loyalty has been a landmark for the organization since its inception in 1904. The association, which has sustained Rugby's hospital and medical services since 1904, is supported by 27 area churches of several denominations.

Today the Good Samaritan Hospital Association, doing business as Heart of America Medical Center, includes a 20-bed critical access hospital, surgical suite and a nursing facility facility.

Haaland Estates, the association's 80-bed basic care facility and assisted living apartments, first opened as an intermediate care nursing home in 1962.

Johnson Clinic, founded in 1933 by Dr. Olafur W. Johnson, merged with Heart of America Medical Center to form Heart of America Johnson Clinics in 2010.
The Hospital
Heart of America Medical Center is a Level V Trauma Center. Lab, X-ray, respiratory therapy, anesthesia and surgical staff are on call 24 hours a day.

In our 18-bed medical/post-surgical unit we provide acute inpatient care and observation. Our state-of-the-art intensive care unit is staffed by registered nurses and physicians certified in advanced cardiac life support.

We also provide swing bed services for people with chronic illnesses or who are recovering from recent
illnesses or injuries who need additional therapy before going home or to another care setting. We also provide chemotherapy, infusions or other treatments on an outpatient basis.
Rugby, ND
Rugby is a city in Pierce County, North Dakota, in the United States. It is the county seat of Pierce County. The population was 2,876 at the 2010 census. Rugby was founded in 1886. (Wikipedia)
Rugby was founded in 1886 at a junction on the Great Northern Railway, where a spur to Bottineau met the main line.  The railroad promoters initially named it the "Rugby Junction" for the famous railroad junction in Rugby in Warwickshire, England, in the hope of attracting English settlers.  About 80% of the population is of North Germanic and Scandinavian ancestry.  When the community became a city, the "Junction" was dropped from the name.  Wikipedia
According to the 1931 U.S. Geological Survey, the geographic center of the North American continent is located approximately 6 miles west of Balta, Pierce County, North Dakota.  The approximate coordinates are given as latitude 48* 10' North, 100* 10' West.  In 1932, a field stone cairn recognizing this was erected in Rugby at the intersections of US Highway 2 and ND State Highway 3.
Rugby has a museum, library, golf course, Movie Theater, swimming pool, parks, playgrounds, hockey arena, ball diamonds, and excellent hunting grounds for waterfowl, upland game, and big game.

I'm back!

I’m back!
I have not been prudent about my blogging for several weeks and for that I am truly sorry. It has not been for lack of “material”, but I have been enjoying spending time with my family.
Since I returned form Alaska last February I have accomplished a few “honey do list” things, spent a week cruising the Western Caribbean, got to watch my son at his Trap meets, went on a few dates with my wife, and worked a few weekends at various facilities in North Dakota.
Now as I prepare to return to Alaska for the summer, it is time to get back to blogging. I have made a list of questions that you have been asking that I will be trying to answer as I go along. I have even been asked to do a product review (to Ralph that was a challenge to “tear something up”) on a new design Cherokee scrub top that I will be posting next week.   Some of you have asked me to tell you about the facilities I work in and/or the communities where I work.  And finally, I get asked a lot of questions about critical access hospitals and “what they actually are”.
So for today, I will share a little history about critical access hospitals and what they mean to our healthcare system.
BACKGROUND
For those of you that have been around a while, you will remember the days in the 80s and early 90s when hospitals were closing across the country. These closings were rampant in large cities as well in rural areas. When a hospital closed in a large city, there were usually several other hospitals in the area to absorb the patient load. Two examples of this are West Paces Ferry Hospital in Atlanta and Baptist Hospital in Memphis. In both instances, there were multiple “other choices” for health care. When these closings happened in rural areas, it presented a different dilemma. There were not other hospitals close by and patients were forced to go long distances for hospital services.  Many of the rural hospitals were not able to stay open due to the rising cost of services and the declining reimbursement rates. This resulted in inaccessibility to healthcare for many citizens.
In 1997, the Balanced Budget Act authorized States to establish a State Medicare Rural Hospital Flexibility Program (Flex Program) by which certain facilities that participate in Medicare would become Critical Access Hospitals (CAHs). The Critical Access Hospitals (CAH) program is designed to improve rural health care access and reduce hospital closures. Critical Access Hospitals provide essential services to a community and are reimbursed by Medicare on a "reasonable cost basis" for services provided to Medicare patients.
REQUIREMENTS TO BE A CRITICAL ACCESS HOSPITAL
A Medicare participating hospital must meet the following criteria to be designated as a CAH:
.Be located in a State that has established a State rural health plan for the State Flex Program (as of September 2011, only Connecticut, Delaware, Maryland, New Jersey, and Rhode Island did not have a State Flex Program);
.Be located in a rural area or be treated as rural under a special provision that allows qualified hospital providers in urban areas to be treated as rural for purposes of becoming a CAH;
.Demonstrate compliance with the CoPs found at 42 CFR Part 485 subpart F at the time of application for CAH status;
.Furnish 24-hour emergency care services 7 days a week, using either on-site or on-call staff;
.Provide no more than 25 inpatient beds that can be used for either inpatient or swing bed services; however, it may also operate a distinct part rehabilitation or psychiatric unit, each with up to 10 beds;
.Have an average annual length of stay of 96 hours or less per patient for acute care (excluding swing bed services and beds that are within distinct part units); and
.Be located either more than a 35-mile drive from the nearest hospital or CAH or a 15-mile drive in areas with mountainous terrain or only secondary roads OR certified as a CAH prior to January 1, 2006, based on State designation as a “necessary provider” of health care services to residents in the area.
Critical Access Hospital (CAH) Payments
Medicare pays CAHs for most inpatient and outpatient services to Medicare patients at 101 percent of reasonable costs.
For purposes of payment for ambulance services, if a CAH or an entity owned and operated by the CAH is the only provider or supplier of ambulance services located within a 35-mile drive of that CAH, the CAH or the CAH-owned and operated entity is paid 101 percent of the reasonable costs of the CAH or entity in furnishing ambulance services. Additionally, if there is no other provider or supplier of ambulance services within a 35-mile drive of the CAH but the CAH owns and operates an entity furnishing ambulance services that is more than a 35-mile drive from the CAH, that CAH-owned and operated entity can be paid 101 percent of reasonable costs for its ambulance services as long as it is the closest provider or supplier of ambulance services to the CAH.
CAHs are not subject to the Inpatient Prospective Payment System (IPPS) and the Hospital Outpatient Prospective Payment System (OPPS).
CAH services are subject to Medicare Part A and Part B deductible and coinsurance amounts.

What this means for rural areas is they have a “local hospital”. Obviously, not all services are available at critical access hospitals, many tertiary hospitals offer “outreach” services for the smaller facilities. Additionalyl, with the advent of telemedicine, many additional services are becoming available in rural communities
Resources
http://www.raconline.org/topics/critical-access-hospitals/
The chart below provides CAH resource information.For More Information About…
Resource
Critical Access Hospitals
http://www.cms.gov/Center/Provider-Type/Critical-Access-Hospitals-Center.html on the CMS website
“Medicare Claims Processing Manual” (Publication 100-04) located at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html on the CMS website
Health Professional Shortage Areas
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses on the CMS website
Compilation of Social Security Laws
http://www.ssa.gov/OP_Home/ssact/title18/1800.htm on the U.S. Social Security Administration website
“Code of Federal Regulations”
http://www.gpo.gov/fdsys/browse/collection.action? collectionCode=FR on the U.S. Government Printing Office website
All Available MLN Products
“Medicare Learning Network® Catalog of Products” located at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MLNCatalog.pdf on the CMS website or scan the Quick Response (QR) code on the right
Provider-Specific Medicare Information
MLN publication titled “MLN Guided Pathways to Medicare Resources Provider Specific Curriculum for Health Care Professionals, Suppliers, and Providers” booklet located at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/Guided_Pathways_Provider_Specific_Booklet.pdf on the CMS website
Medicare Information for Beneficiaries
http://www.medicare.gov on the CMS website


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