Tuesday, July 11, 2006

Day 2

Day two begins of my daily blog entries.  Again, part of that whole "make sure you write in order to feel balanced".  Thank god for blogging tools.

So as I sit here on the bus I'm at 6488.  Lisa, my cohort at work who we seem to be in friendly competition lately, was at about 7400 steps.  I still have my walk home from the stop though to gain lost ground.  If we do an evening walk I'll be able to surpass her.

It's been sort of odd, my relationship to this coworker.  There's a lot to like.  She's older, but she's bubbly and just acts like she's about my age.  At lunch we banter about work, or talk about work stuff.  We bicker in a friendly manner but there's a very mutual admiration.  I look up to what she's achieved and how fast she's come in the crazy world of healthcare finance.  She looks up to me for my perceived "vast knowledge.  She takes my advice in a very literal way.  She's also a work relationship that habitually just stays at work.  At work, however, she's a very direct influence on my moods and I generally expose my actual mood to her more than others.  Not sure why.

Bleh, anyhow, we had a few challenges in our day.  Meditech is a very complicated system. I had the realization that procedurally it was similar to learning how a natural gas plant works. For a short time I worked for a natural gas treatment plant. I was a roustabout. Work involved learning (sounds like a resume, ha) what the pipes all went to. I learned how one set of pipes influenced a part of the process, that certain pipes lead to certain tanks containing certain chemicals in either dehydrating the natural gas or removing noxious elements from it (sulfer etc). Each system influenced the other, if the pressure of one tank was off the entire supply line was affected. Changing one variable, altered the variabls of the entire treatment process. Meditech is very similar. Everything is connected in a way. Take the fact I just work in the business office and there are literally thousands, wait, tens of thousands of variables available to someone in order to meet the seperate thousands of variables in medicare compliance, and then add a module for each department of the hospital with their own thousands of variables and you start to get the idea of the ridiculous complexity you can get to in a facility like this.

Not all hospitals are this way. Some are simpler, some are more complex. It's about the variety of services a facility provides. For example, a hospital that just held people and did x-rays. You'd only be doing one type of billing. Take another hospital that does chemotherapy, short term inpatient care, short term acute inpatient care, intensive care for newborns, physical therapy, lab, and outpatient surgeries like gall bladder removal. Each of those categories falls into its own unique set of regulatory requirements set forth by "Medicare"..."Medicare" even structurally is complex. First you have the politicians, then you have the money people setting the budget after the politicians decide on things. Then you have the people that end up in "reality" who re-do the budget to make it reflect reality. Then it passes onto the federal department of human services who gets the budget and then they make policy decisions. They say we will cover things that are medically necessary. They help figure out what's medically necessary and how it's all going to be regulated. This then gets described in the Federal Register, which is sort of the all-encompassing document for recording what the government thinks it's suppose to do. From this, it then passes onto a division of the department of human services called "CMS". "CMS" is actually an acronym for "Centers for Medicare and Medicaid Services". CMS actually decides in great detail how it's all going to work logistically. They figure out what forms are going to be used, how the facilities/doctors identify themselves, classifies said "providers" as in providers of service, lays out the requirements for some of the coding, prices the coding, then coordinates with the fiscal intermediary how the pricing works with individual providers, gets the doctors together to see if what was previously defined as "medically necessary" actually is medically necessary and uses this medical review to help define how a service is appropriately performed. Cripes...I could just go on and on and on....logistics....that's what they do. The buck then passes onto what's called "Fiscal Intermediaries". These are the guys who get a check cut by CMS, and then they doll out the funds to the "providers" that bill them. It's all fee-for-service, so it's not like they (at this present time) "run out of money" and stop paying...but that could change. Think of fiscal intermediaries exactly like it sounds, they are intermediaries or rather middle people for the money. They take what CMS instructs them on as far as logistics and then implements it. They of course adhere to protocol for implementation, but each "FI" as they are called has their own quirks.

I haven't even touched on the OIG yet.  The OIG is the Office of Inspector General. Some people confuse where this agency fits into the federal government. The OIG is actually a branch of the federal department of human services, not a general agency responsible for "inspecting". These guys stick to healthcare. In the branch of things, they are on the same limb as CMS, but under DHS. These are basically the guys you hope you never hear from. They bust your ass. I'm not saying they only bust your ass if there's a problem, they bust your ass period. Not to say that they are "bad people" or a "mean agency". The system is just inherently so complex that it cannot be adhered to completely, and thus whoever gets audited has problems. Yes, by the way, the system is inherently too complex to be expected of a facility to be %100 compliant. It's like looking for a review of something and finding the truly perfect "10 out of 10". Whenever the 10 was given, something's shady going on or the person giving the 10 isn't legit. 10's in healthcare do not truly exist.

Let's see, what else can I ramble on about....ahh yes something I am passionate about...video games. Yesterday I acquired something that would help me out in my portable laptop gaming, a USB controller. I got the "Game Elements: Recoil". They prominently refer to it as its model number, GEG909. It was cheap, walmart deal, about 15-16 bucks. I mainly wanted it for playing Freespacec2 in OSX. To my delight this cheap controller is just about perfect. It's a dual shock controller with note-worthy features. It has keyboard/mouse emulation and vibration in addition to your standard-fare dual shock controller. However, both of those features don't work in OSX. Given that I want to play a space sim and maybe some SNES emulation, vibration and kb/mouse is completely an afterthought. I was pleasantly surprised with another feature of this controller, the recoiling cord. When you're done, unplug and push on the "recoil" switch at the top of the controller and the USB cord recoils perfectly out of the way, perfect for storing on the go. It can get in the way by trying to curl up as you play, but once you manage to get a feel for handling the cord it does not get in the way. It's a matter of only giving it so much slack, leaving just enough for moving around, and it stays out of the way nicely. Its accuracy is wonderful, and the tactile feel is really well done. It was very easy to assign the pitch, bank, and turning axis between the two sticks and then just customizing the "joystick" buttons as I pleased. Freespace2 SCP by the way is well suited for this type of customization even in OSX. The coders did superb in this port, even if rough around the edges. I still challenge you to find something as cool as the Psamtik's new look in another game.

Which is another thing worth mentioning...HOW COULD THIS WORK BE GOING UN-NOTICED??!?!? The new artwork looks incredible. They've really updated the look of this game into something very splendid. There are a lot of gameplay scenes I've had in the game so far that actually look BETTER than the cinematic ship flights. It looks very reminiscient of the intro to the original Freespace. The new subspace effects with new 3d effects are also awesome. The way the inside of the subspace collapse begins and ends branching out with a very eye-catching blue flare as jumps open and close. When I first saw the carthage and dashor show up, those two brilliant subspace flares were enough for me to have lost my shield strength dramatically to just about zilch. During gameplay I saw the two jumps happening and I just stopped. The Shivan fighter left my target reticle, went completely off screen as I just stopped, staring at how cool the new effect was. All I can describe it as is cinematic, but better than the subspace effects in the cut-scenes. These modders really went above and beyond and did something very cool in it. Also, the following treat was just in watching the two ships get into a knock-down fight against the Rakshasa. The Shivan beam effects are equally as cool. This isn't just Freespace 2, this is Freespace 2 practically re-made. The gameplay experience as it was, was already good...but pile on these insanely cool graphics and effects...and you have a new game. Bravo, hats off, I am addicted to a new game for the time being. Don't look at this as just an open-source project. Look at this and compare it to full-scale commercial production, these guys are pulling off something truly awesome. You have just got to see it, and if you're already a Freespace 2 fan, prepare for a lot of jaw dropping. It's that cool.

Another thing worth noting is this whole Japan and North Korea thing. I love the Japanese, I love their courage and honor. They really have a lot of guts to stand up and say what they are saying. If I can speak on behalf of the US, I'd say to them that we're right behind them %100 in what they are doing. If it came to war, being patriotic about that country would come just as easy as it does for the US. However, I do have to wonder what they are leading into. Not that I oppose striking North Korea, but I wonder what it would galvanize against our interests if the world were to see Japan militarizing. The Chinese seem to remember very well the Nanjing March, and they probably want nothing of that even being possible again. If I were China, I'd have some fearful twitches whenever Japan talks about things like "preemptive strike" against anybody. The Japanese have proven throughout history that they are a people about possibility in anything. I admire them, and support them...but I have trepidation about them deploying their military anywhere outside of their own soil. Not that I don't think a preemptive strike should happen. What I really wish for is that Japan felt comfortable enough with the US as an ally that they could negotiate us striking North Korea in their protection. The US has a lot in Japan, we need them very badly, and it's completely in our interests in this case to wipe out NK's military capability. We absolutely should, in fact, be taking care of the "North Korea problem" instead of the Iraq problem. North Korea and their intents and ability to cause problems were vastly greater than Hussein's Iraq was. Alas, I don't have the intel Bush had, so who knows. *shrugs*

Look for an update on the final steps walked...I'm just wanting to listen to music now.

7890 seems to be the final number for today.  Would have walked more, but mosquitoes are out pretty bad. We'll see tomorrow.


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