Hospital Math

Miss Tattle cracks me up. I think there is an intelligent human being in there somewhere - sad thing is, I'm not sure where.

Now, y'all know that Miss Tattle does her best to make my life rough. She's a mean-spirited soul, and it gives some part of her great joy to create angst in someone else. Of course, since I'm leaving to take a job she'd dearly love, she tries to be on my case as often as possible. Jealousy has reared its ugly head in that one, Grasshopper.

Even our new boss has figured out that sending the trainees out with Miss Tattle isn't a good idea. Miss Tattle doesn't like to be "tied down" to the patience factor needed when teaching a rookie vamp. And, in spite of that, it frosts Miss Tattle when I take two rookies with me at the same time. How dare I be able to take two people at the same time? So, I've spent a great deal of time with our four new trainees in the last month. One of them was my student last semester, so I encouraged her hiring heavily, and apparently it had some merit since they hired her even before the semester was over. And, two more of my students have been hired for other shifts; makes this teacher's heart sing, truth be told.

But, back to Miss Tattle.

The team finished up really early today, so as cancellations were being done, a couple of trainees were sitting in on the computer cancellation process. It's a process that is done, basically, 'by rote'. You don't really have to know "why" you do it, just "how" it is sequenced. But, at the same time, if you're training someone, it's a good idea to know how it all works in case someone is curious enough to ask.

I didn't have anything to do right then, so I was leaning against the counter, idly listening while one of the folks showed the canceling to one of the trainees. It went something like this:

1. Put in the patient's hospital number.
2. Put in the numbered cancellation code for why the tests were cancelled. (this would be due to a nurse draw, a picc line, a doctor order, etc.)
3. Credit the patient.
4. Check off the tests that are cancelled, and footnote appropriately.

So, on about the third cancellation, something caught my attention and made me actually listen, rather than just hear noise. It happened on #3.

"It says 'credit' here. Put in 'Y' for yes. I don't have any idea why you check that, but you do."

I butted in.

"You don't know why you're crediting the patient?"

"No."

"Would you like to know?"

"Yes," (both trainer and student replied.)

So, even though I was pretty surprised by the trainer not knowing this, I simply said, "Let me tell you why, then. You should know why you do this, at least."

And, I explained that when tests were ordered, each test, or battery of tests had a set fee. On top of that, there is a phlebotomy charge for each draw we do. In our case (at least two years ago) the fee is right around $60.00. Those charges are assessed prior to the team leaving the lab.

So, if we don't draw the patient, we need to credit those tests and the phlebotomy charge so the patient or insurance company doesn't get billed for them. Simple. Logical. If nursing draws it, it gets charged through their accounts, not the lab accounts.

Miss Tattle was listening in on this conversation, as were a couple of other full-time phlebs. (Remember, I'm a part-timer, so I guess that's automatically supposed to make me stupid.)

"Kate...it's not $60.00. That's way too high a charge!"

"Sorry, Miss Tattle, but it was that high two years ago when A SUPERVISOR told me what the fee was."

"No, you're wrong."

"Sorry. You'll have to find a supervisor to tell you what the fee is, then."

"Kate...it CAN'T be that much!" (Sheesh, have you looked at the price of medical care these days? $60.00 is a drop in the bucket.)

"All I know, Miss Tattle, is that I didn't make this up. A supervisor told me the fee."

Another full-timer chimes in.

"$60.00???? And we only make $10.00 hour? We need to make more money than that! More of that charge should be OURS!"

(I'm mentally struggling to hold my jaw from dropping to the ground, because she'd inadvertently dropped what she makes per hour. And, I make considerably more than she does. So much for full-time versus part-time.)

So, then I'm trying to explain to a hostile audience that this is not a straight across the board fee that *we* get; a portion of that is our hourly pay, but also includes equipment usage, lab overhead fees, etc.

Neither one of them "got it". Miss Tattle was too busy trying to convince the lab I didn't know my ass from a hole in the ground, and the other one was pissed because all she could see and think was that she is getting screwed on her paycheck.

Apparently, no one has ever told them that a hospital is in business to make money, or at least broken it down in a way where they can see 'how' it's possible for a hospital to make money.

It boggles the mind.