That by asking a simple billing question, the Supervisor was called in and stated to me that the admin did not like my asking, that with that attitude, they did not want me as their patient. The surgeon was the customer and not me.
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​To speak directly with the surgeon to determine what assessment was necessary to determine any changes he needed to know for my elective surgery, when there was no change in my condition; and to let me know what follow up blood work I could get done without any office visit, for his updated information to perform the surgery safely.

While speaking with the hospital, I should have pushed back to get scheduled with the right physician using the correct terms. I was able to call back after HC Aware and let them know that my son has no behavioral issues and I don't need to go down from a Pediatrician to a PA driving up costs with unnecessary office visits and assessments, especially with a detailed journal of symptoms and elimination of possible contributing factors already chronologically listed. 
By pushing back, I was able to get an office visit with the right specialist who could reassess and order an MRI to focus on a diagnosis, and not give him medications to address the symptom of a headache without getting a proper diagnosis. 

To have a patient champion on the phone because I was stressed during the visit and the doctor only ordered blood work and I did not immediately ask why he was ordering those specific labs when he was not showing any symptoms for what he ran (e.g. anemia). 

Feeling tired and overwhelmed, by having a patient champion on the phone during the visit, I would have pushed back immediately to avoid unnecessary blood work, the only thing he concluded, "Some people just live with headaches." There was no diagnosis and no order for a MRI to rule out issues causing constant headaches for months. I would have not left frustrated, confused and being told to journal his headache for months, when I had already just did a journal for months of his headache. I left without a diagnosis or order for an MRI to establish ruling out possible causes in his head.

Hospitals are reviewed by the Center for Medicare and Medicaid Services (CMS)/insurances and will receive denials of payment if there was not a medical necessity to be there. It is important to partner with clinicians and Case Managers when it is ambiguous regarding the correct, safe and proper treatment for Inpatient versus an Outpatient, because "Insurance claim denials cost hospitals $262 billion annually", and so, hospitals should never be treated as a hotel or doctor office.  

Hospitals are reviewed by the Center for Medicare and Medicaid Services (CMS) regarding denied reimbursement if I come back in less than 30 days with the same condition, and so it is important to make sure that I am receiving the right code associated with my admitting and discharge primary diagnosis for accuracy of my care. The Care Manager can assist if there are any questions regarding admission & discharge coding of diagnosis in my medical record.

The staff should tell me or write down the lab and value they were monitoring, the name of the procedure, or I should have recorded with my phone. The procedure should have been done when his blood work was stable so he could go home for the holidays. 

The number of days as an inpatient is public knowledge. My dad should only have been in the hospital for
4-5 days; I could have called case management or the Chief Experience Officer for the hospital. ​[see resources, file for # days in the hospital]

Value based care is the new standard for reimbursements, and that especially means medical care coordination = no one should be walking into my dad's room without first having been briefed from the primary doctor/nurses - having already read the $100M electronic medical record (EMR); and only asking clarifications, doing a thorough assessment, and instructing on the plan of care with outcomes, timelines, and any specific-necessary doctor who is to be involved.

They were supposed to be assessing my elderly mom to make sure they were not causing a hospital acquired condition (HAC), such as pulmonary edema when her GFR was 52. The nurses should have been touching her to see her swelling (edema); they were supposed to not only be tracking her urine amount, but straining it to see if stones passed, and have her on a bed that automatically weighed her to see that she was retaining fluid which is dangerous with someone with high blood pressure (hypertension).
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​Clinicians should always assess the patient - look, listen, feel - even when stable to always have a baseline, and to monitor if treatments are being successful, to avoid complications before machines alarm.

The difference between a living will and advanced directives, so having a 'Do not resuscitate' (DNR)/no code status, to also have an open discussion with advanced directives documents clearly defined when to call an ambulance, and when to leave my mother, allowing her to go peacefully in her home when it is her time - without invasive treatment.

​My primary care physician had me on meds that caused my sodium to drop and he never checked it, and there was no care coordination with any of the other five doctors he kept referring me to.​

Numerous staff throughout the three days should have been doing level of consciousness (LOC)/awareness checks to note the increased confusion which can be caused by raising sodium too quickly; they should have contacted the primary physician for the last time labs were checked, and the discharge planning status was not supposed to be To Be Determined (TBD) two hours after the discharge order was written; planning should have been initiated the first day admitted. 
A hospitalist who had never seen me wrote the discharge summary incorrectly, changing it from the admission of low sodium (hyponatriumia) which i was treated for, to reflect symptoms for low potassium, with the discharge diagnosis of hypokalemia.

There is a difference between experience questions that do not reflect quality care delivered, and that of value care delivery along with engagement questions. There is a Population and Experience Officer in health systems and to contact them regarding poor care coordination, clinical quality assessments and poor engagement and listening of extended family members - while still in the hospital to ensure good care.