Last night after work hubs and I met daughter, her fiancee, and his mother and father for a taste testing for the reception. OMG the culinary delights.
We started with a choice of either soup (minestrone, Orecchiette con Fagioli or the chef's soup of the day which was Cream of Broccoli) or salad. We decided on offering either a choice of Minestrone or salad.
Next we had to pick the pasta. We had bowtie pasta with a vodka cream sauce and then homemade cheese tortellini in a pomodoro and basil sauce. We all agreed on the vodka cream sauce but couldn't decide on bowtie pasta or rigatoni or the cheese tortellini.
The next course was the main course. We knew we were having filet and chicken but we had yet to pick out which chicken so they brought out 2 12 ounce Filet Mignons, Chicken Vesuvio, Chicken Marsala, and Chicken Francese so we could have both a slice of the filet on our plate with each of the chickens to get the flavor of how both would be presented. We loved all of them and the vote was split 3 ways.
We also had to pick out our potatoe from these: Twice Baked Potato, Oven Roasted Potato, Vesuvio Potatoes, Garlic Mashed Potatoes, Crocka D'Potato, and Italian Potatoes. We are between the twice baked, the vesuvio if we have the chicken vesuvio, or the Crocka D'Potato.
Oh and one can't forget the vegetable choices: Steamed Broccoli, Asparagus, Green Beans Almandine, Sauteed Spinach, and a Garden Fresh Medley of Broccoli, Cauliflower and Carrots. I think we are going with the green beans almandine as they gave the best presentation on a plate.
The owner of the reception place came over to see us (he knows us) and said we couldn't leave without dessert so he brought out Lemoncello Gelato, Tiramisu, and Cannoli's. I had never had lemoncello gelato before so I had that.....melted in the mouth.........truly orgasmic!
The whole dinner for 6 was a part of the reception program so all we had to pay for was the 2 bottles of wine we drank (well, I had water).
OMG I was so full and we still can't decide. We might just have to go back to pick one pasta and one chicken and one potato and one vegetable and do some sampling all over again. Hard decisions here.......
Thursday, October 11, 2007
Sunday, October 7, 2007
Dreams
I had the weirdest strangest dream last night and I had to tell you all about it to see if someone can help me interpret it. According to a website called "An Online Guide to Dream Intrepretation", the rules of reality do not apply to the world of dreams and said dream "unifies the body, mind, and spirit". Umm...yeah...kinda scarey!
Now I usually don't dream or remember my dreams. I am usually so tuckered out by the time I go to bed that I am a log. My head hits the pillow and I am out. The next thing I remember is the alarm going off. I have had to stop reading when I go to bed because I fall asleep so fast anymore that I leave my glasses on all night. I learned that to try to see out of twisted glasses is not good in the am, let alone deal with the cast! On to the dream:
I dreamt that hubs and a friend of his, daughter and I, and a wiener dog were all going from wedding reception to wedding reception place looking for the best one for my daughter. The corker: instead of visiting said places during the day, we visited them during actual weddings. I don't remember my attire but I do remember some of the attire worn by some of the wedding attendees (all the way from black tie and glittery dresses to overalls and tennis shoes). There were at least 5 different weddings going on at each place. Daughter, wiener dog, and I would visit each wedding and talk to the people attending and the guide who was telling us what they could do for us. Hubs and his friend were going from wedding to wedding sampling the food. Wiener dog was having fun and in fact at one point we lost him and had to go find him. Once we found him dancing in the middle of a circle of people and the center of attention. Another time he was lying in the middle of the lawn not wanting to move. That's all I remember.
Ok, #1: I would never ever own a wiener dog although my niece and grandniece do. Hubs and I did get a call yesterday to see if we wanted a 4 month old English Bulldog male puppy and we said no.
As for daughter's reception, we never looked at any other place than the one she is having hers at because we know the owner and love the place he and his sons built. It also has special meaning because the owner used to have an Italian restaurant we inhabited a lot when the kids were growing up. They had this scrumptious Italian family feast on Sundays...all you could eat and the kids were free. Also we knew what was out there because we attend weddings of either our kids friends or friend's children's weddings and our banquet place beats them hands down for authentic Italian food.
So what does my dream mean other than I am nuts, weird, and strange? And what does wiener dog have to do with any of it?
Now I usually don't dream or remember my dreams. I am usually so tuckered out by the time I go to bed that I am a log. My head hits the pillow and I am out. The next thing I remember is the alarm going off. I have had to stop reading when I go to bed because I fall asleep so fast anymore that I leave my glasses on all night. I learned that to try to see out of twisted glasses is not good in the am, let alone deal with the cast! On to the dream:
I dreamt that hubs and a friend of his, daughter and I, and a wiener dog were all going from wedding reception to wedding reception place looking for the best one for my daughter. The corker: instead of visiting said places during the day, we visited them during actual weddings. I don't remember my attire but I do remember some of the attire worn by some of the wedding attendees (all the way from black tie and glittery dresses to overalls and tennis shoes). There were at least 5 different weddings going on at each place. Daughter, wiener dog, and I would visit each wedding and talk to the people attending and the guide who was telling us what they could do for us. Hubs and his friend were going from wedding to wedding sampling the food. Wiener dog was having fun and in fact at one point we lost him and had to go find him. Once we found him dancing in the middle of a circle of people and the center of attention. Another time he was lying in the middle of the lawn not wanting to move. That's all I remember.
Ok, #1: I would never ever own a wiener dog although my niece and grandniece do. Hubs and I did get a call yesterday to see if we wanted a 4 month old English Bulldog male puppy and we said no.
As for daughter's reception, we never looked at any other place than the one she is having hers at because we know the owner and love the place he and his sons built. It also has special meaning because the owner used to have an Italian restaurant we inhabited a lot when the kids were growing up. They had this scrumptious Italian family feast on Sundays...all you could eat and the kids were free. Also we knew what was out there because we attend weddings of either our kids friends or friend's children's weddings and our banquet place beats them hands down for authentic Italian food.
So what does my dream mean other than I am nuts, weird, and strange? And what does wiener dog have to do with any of it?
Saturday, September 29, 2007
Anxiety/Panic Attacks
I am sure I am not the only one who has ever felt anxious. As a parent we feel anxiety as soon as our child is born. We worry about our kids every minute of their lives. If you are a new parent and think that worry will lessen as they age....you can't be more wrong. It increases with driving, dating, moving away, etc.
Lately, I have been having anxiety attacks. I don't mean the kind where we dream we run out of the house without any clothes on...or worry we are going to get into a test and forget everything we ever learned.....or worry about a big dinner or party we are putting on and worry you are going to poison your guests or the souffle will fall or your timing would be off on your things you are making or will forget to get something you made out of the frig....or worry if a family event will turn out ok and you say what you really felt to some members of said family you can't stand.....or worry you forgot to turn off the stove or coffeepot or lock the dooots.....or you forget who you are in front of a crowd of people and worry you won't be able to utter a sound or sound intelligent. I have had those all my life. I remember once someone told me to think of the audience naked. Ok that never worked on me. Instead of remembering why I was there I saw the audience naked in my mind and all I could do was bust out laughing.
I digress. When you get one of those attacks, they are full blown heart pounding, butterflies in your stomach, thoughts that overwhelm you so much that it is the only thing you can think of. And if yours are like mine, they are usually blown out of proportion to what is really going on.
Yesterday I had a major one. It all started when I was at the hairdresser and without glasses or facing the TV (this is important). I was listening to a news program. The salon I go to was busy and there was a lot of chatter going on. I was listening to the news. There was a story about a woman missing in a town. Now normally that wouldn't faze me at all. This story did. I have a friend whose first name was the same as the missing woman. They both lived/worked in the same town. The police were actually interviewing the husband of the missing woman as a suspect. In my mind, I instantly thought it was my friend. I started thinking (which sometimes is a bad thing with me). I couldn't stop thinking about it.
My husband picked me up at the salon and took me to the chiropractor. I scooted in to see them with this still weighing on my mind. I was trying to remember when I last saw her post and for the life of me couldn't remember. I started worrying big time about her. I put into my mind that this missing woman was my friend. By the time my husband came back to pick me up, I was a basket case. Immediately I got on my cell and in a panic, called another friend to get the last name of the woman who was missing. I could have waited the 15 minutes to get back home to do it myself. But no, I just had to know right then and there. I had already been worrying for over 2 hours. I was not waiting 10 more minutes.
Thank goodness for my friend. She calmly looked the story up and we found out it wasn't our mutual friend. Let me tell you, the feeling of peace and life was ok again so totally overwhelmed me that I swear I could have fallen asleep. I didn't realize how worked up I had gotten until that moment.
I blame them on my inability to live and function as I used to and the daily frustrations I experience just getting around. It does not get better after even 7 weeks and I have 5 more months to go.
Lately, I have been having anxiety attacks. I don't mean the kind where we dream we run out of the house without any clothes on...or worry we are going to get into a test and forget everything we ever learned.....or worry about a big dinner or party we are putting on and worry you are going to poison your guests or the souffle will fall or your timing would be off on your things you are making or will forget to get something you made out of the frig....or worry if a family event will turn out ok and you say what you really felt to some members of said family you can't stand.....or worry you forgot to turn off the stove or coffeepot or lock the dooots.....or you forget who you are in front of a crowd of people and worry you won't be able to utter a sound or sound intelligent. I have had those all my life. I remember once someone told me to think of the audience naked. Ok that never worked on me. Instead of remembering why I was there I saw the audience naked in my mind and all I could do was bust out laughing.
I digress. When you get one of those attacks, they are full blown heart pounding, butterflies in your stomach, thoughts that overwhelm you so much that it is the only thing you can think of. And if yours are like mine, they are usually blown out of proportion to what is really going on.
Yesterday I had a major one. It all started when I was at the hairdresser and without glasses or facing the TV (this is important). I was listening to a news program. The salon I go to was busy and there was a lot of chatter going on. I was listening to the news. There was a story about a woman missing in a town. Now normally that wouldn't faze me at all. This story did. I have a friend whose first name was the same as the missing woman. They both lived/worked in the same town. The police were actually interviewing the husband of the missing woman as a suspect. In my mind, I instantly thought it was my friend. I started thinking (which sometimes is a bad thing with me). I couldn't stop thinking about it.
My husband picked me up at the salon and took me to the chiropractor. I scooted in to see them with this still weighing on my mind. I was trying to remember when I last saw her post and for the life of me couldn't remember. I started worrying big time about her. I put into my mind that this missing woman was my friend. By the time my husband came back to pick me up, I was a basket case. Immediately I got on my cell and in a panic, called another friend to get the last name of the woman who was missing. I could have waited the 15 minutes to get back home to do it myself. But no, I just had to know right then and there. I had already been worrying for over 2 hours. I was not waiting 10 more minutes.
Thank goodness for my friend. She calmly looked the story up and we found out it wasn't our mutual friend. Let me tell you, the feeling of peace and life was ok again so totally overwhelmed me that I swear I could have fallen asleep. I didn't realize how worked up I had gotten until that moment.
I blame them on my inability to live and function as I used to and the daily frustrations I experience just getting around. It does not get better after even 7 weeks and I have 5 more months to go.
Sunday, September 23, 2007
High Maintenance - Ankle - Cast - Bridesmaid Dresses
I promised you a picture of how my employees decorated the scooter for me and here it is. My dear husband took away my horn and put it in an area I can't get to even with the crutches. I wonder if I was using it a bit too much? *hehehe*
This is a picture of my purple cast. My employees want to paint my toenails tomorrow...one says she has the perfect polish for me. I dunno....I rarely paint my toenails...just too much hassle and I rarely wear sandals. I just have other things to do with my time.
Baby shower went fine yesterday. I am glad I can't have anymore because I swear something was in the water around here. Out of the 75 women who were at the shower, there were 30 of them pregnant. There were only 10 of us who either didn't have a kid under the age of 7 there or wasn't pregnant. It was chaotic but fun and a nice diversion for me.
Things are progressing with my new client. There has been continued drama from the people who were let go or job definitions changed plus someone she had hired before and let her down tried to step back into the picture promising her the world yet didn't produce the things she was told to bring to the meeting.
As for me, hubs got his new computer in a week or so ago but I haven't had time to transfer his documents nor put his programs onto his new computer (mainly his EMR program), etc. I have been working on doing that since Friday along with getting the new database done for the client so I can start billing for her and getting her some cash flow. I have gotten hubs new computer all done and his documents and programs off his old computer. I have transferred my programs from my old laptop to hubs old laptop but am still working on getting the rest of the files transferred. Then I will delete my files off my old laptop and give it to my daughter. I have a few more hours to finish and should get that done.
Wedding plan update: invitations, programs, place cards, announcements, menu for reception, thank you cards, invitations for bridal shower all picked out and ordered. My daughter chose to scrapbook all the above so guess I will learn to scrapbook. We have 4 months before we have to mail them but only 2 months for the shower invites to be finished and mailed. Hopefully that will be enough time to get them done. There might not be a Christmas letter this year.
Bridesmaid dresses picked out...here is a pic but it will be in a light pink. Groomsmen will wear a black tux with silver vest. Groom will wear a black tux and white vest. Daughter will use shades of pink in the bouquets and pull in the silver into the ribbons. Still so much to do.
This is a picture of my purple cast. My employees want to paint my toenails tomorrow...one says she has the perfect polish for me. I dunno....I rarely paint my toenails...just too much hassle and I rarely wear sandals. I just have other things to do with my time.
Baby shower went fine yesterday. I am glad I can't have anymore because I swear something was in the water around here. Out of the 75 women who were at the shower, there were 30 of them pregnant. There were only 10 of us who either didn't have a kid under the age of 7 there or wasn't pregnant. It was chaotic but fun and a nice diversion for me.
Things are progressing with my new client. There has been continued drama from the people who were let go or job definitions changed plus someone she had hired before and let her down tried to step back into the picture promising her the world yet didn't produce the things she was told to bring to the meeting.
As for me, hubs got his new computer in a week or so ago but I haven't had time to transfer his documents nor put his programs onto his new computer (mainly his EMR program), etc. I have been working on doing that since Friday along with getting the new database done for the client so I can start billing for her and getting her some cash flow. I have gotten hubs new computer all done and his documents and programs off his old computer. I have transferred my programs from my old laptop to hubs old laptop but am still working on getting the rest of the files transferred. Then I will delete my files off my old laptop and give it to my daughter. I have a few more hours to finish and should get that done.
Wedding plan update: invitations, programs, place cards, announcements, menu for reception, thank you cards, invitations for bridal shower all picked out and ordered. My daughter chose to scrapbook all the above so guess I will learn to scrapbook. We have 4 months before we have to mail them but only 2 months for the shower invites to be finished and mailed. Hopefully that will be enough time to get them done. There might not be a Christmas letter this year.
Bridesmaid dresses picked out...here is a pic but it will be in a light pink. Groomsmen will wear a black tux with silver vest. Groom will wear a black tux and white vest. Daughter will use shades of pink in the bouquets and pull in the silver into the ribbons. Still so much to do.
Wednesday, September 19, 2007
New toy
I consulted a surgeon on Monday and he recommended a non-weight bearing cast for another 2 weeks and then we will see when surgery will be. I can't stand on my ankle at all without either the cast or a brace on and even with them it is really painful. I still have my wheelchair but I still needed the crutches for small areas which killed my left hand (still in splint/cast) and my left knee (still in splint). Being non-weight bearing is a pain. Well today I am taking delivery of this gorgeous scooter. I can't wait. It is lightweight so I can drag it upstairs with me when I go up on my rear. It is smaller so it will go in the bathroom. Plus it will let me be a bit more mobile. Granted I am getting a lot accomplished sitting on my rear but said rear is spreading. I need it exercised. I tried scooting across the floor on my rear but that gets tiring let alone I have rug burn butt now. Crawling is out of the picture because of the left knee and cast on the right foot. I am so excited! Great inventions!
Cast colors are all the rage! In the past 5 weeks I have worn a red cast, a Chicago Bears cast, and a green cast. This time I have a neon purple cast. Now I am 53. My leg hair doesn't grow much anymore or I should say it didn't used to. Seems the cast has miracle grow in it. Those leg hairs are at least an inch long now. AND I CAN'T SHAVE THEM. The leg has been in the cast so long, the skin is softer. If I shaved, I would remove a layer or 2 of skin. The cast itches enough without razor burn under there too. So instead before I let them put the new cast on Monday, I gooped up the leg with zinc oxide and it made it feel much better or at least so far.
Monday's appointment was a one stop shop. I had the hand doctor see me about the hand. I then saw the knee doctor for the knee, then the podiatrist for my ankle. All in the same office. They came to me. 3 copays though...one for each doctor.
It is also official. I now have a handicapped tag for the car. I had resisted getting one but it is hard for people who take me places to let me off along with my equipment then go park the car, then walk back and reverse that to put me back in the car. It's only a temporary one for 3 months. Let's pray that is all it is. I want to walk down the aisle for my daughter's wedding.
By the way, I will love the basket on the scooter. I was becoming a bag lady carting things around in a plastic bag. Also there is a bell like those on bicycles. I can't wait to play with that one although I was getting handy with the crutches and using them to get people's attention (mainly my husband). I can propel the crutch much in the same way track kids do the javelin.
Sunday, September 16, 2007
My 2 days of Managerial Consulting
I wrote this in my journal about the consulting job I did this past week. Thought I would give you an insight into what I did and because I can't think of anything else to blog about and I don't want to talk about my foot and ankle.
Wednesday: Right now I am sitting in a hotel room getting ready to do that consultant work on a doctor's office starting tomorrow. I had a full day already today with the officer manager's meeting I did from 8am to 1:30pm then went to the L office and worked there until 7pm when L picked me up to come up here. We made it up here in less time than I anticipated. We elected to have separate rooms mainly because I needed a handicapped room and those only offer 1 queen sized bed in them. Sharing a bed with another female especially one who is your employee is not good for me. I have the splint on the knee, the splint on the hand, and the cast on the ankle plus I am used to sleeping in a king sized bed and tend to do the snuggle thang. Not good if I am in a smaller bed and with an employee. Wonder if that would fall under employer sexual harrassment? Anyway, I am sitting here drinking a glass of milk going over my game plan. I can't get on the internet because the secure wireless connection wasn't working. My brain is still wired from today's activities and I can't concentrate on the book I brought to read. Called hubs and we talked for a while. The doctor called and we set up the time we were meeting for breakfast so guess I better get to bed since it is now 11pm and the alarm will go off at 5am.
Thursday: Met with the doctor for breakfast then over to the office. Met all the employees. Within the 1st 15 minutes I had a headache from the chaos of the office dynamics. So game plan changed and I decided to change what I did when. I started with handing each employee an unlined piece of paper. I then gave them the instructions that they were to write on one side what they did and on the back what they thought each other employee did. After collecting those, I spent 30 minutes with each girl and then had L do the same, taking notes all the time. That took up the entire morning. Lunch was takeout from a local burger place (and yes although I hate hamburgers, I snarfed it down because I didn't know when my next meal was going to be). Then it was time for patients. I reobserved how the patient and paperwork flow was and took notes to compare that to what it was like without patients. I thought it was chaotic before...OMG it became psychotic. It was really hard to keep myself focused when everyone around me was so disorganized and the whole flow was so disruptive. I am actually surprised they had a practice at all. I then 'became a patient' and went around experiencing what they were seeing and doing, how long wait times were, seeing what they were seeing as far as room decor, cleanliness, etc. Around 4pm I started in learning their software system and after seeing that no one really knew what reports the software they were using could produce, I called their software management people and got trained fast. I ran reports and compiled them for anaylsis later. I looked up and it was 8pm so we took off with everything and went to dinner with the doctor and office manager. Really nice place....called a supper club and decorated 50's style.....great food though and fantastic view of Lake Michigan. Right now I just got finished analyzing the data and reports which were off the wall. AR (accounts receivable) was off in outer space with most of their AR in the 120+ days. Interesting was the fact that there was no AR for the 0-30, 30-60, or 60-90. That meant that NO billing has been done for at least 3 months at all. I found this one report called the unsubmitted report which means the charges were entered into the computer but not submitted to the insurance company. Normally there should be zippo unsubmitted. The report was 22 pages long and included charges dating back to 2005. What I found most interesting though was what I had the employees do (the job description of themselves and each other employee). I found there only to be 2 employees who knew what the others were doing. The others instead of listing the names of the employees listed them instead by department letting me know they didn't even know their names. Also interesting was how they followed directions. One employee got lined paper to write hers on totally going against the instructions. Then I analyzed their handwriting which told me what I had already found out that day. Interesting things you find in handwriting analysis. I complied my observations and plan to go over with the doctor tomorrow at breakfast again at 7am. Before we left the office the doctor got an email from one of the employees...calling me a bitch and interfering and that if the doctor was going to listen to me then she was quitting. Interestingly enough she was the one who didn't follow directions and also the one who couldn't produce what she was working on and contracts the doctor was credentialed with. She just gave me excuses. Note she is paid 40 hours to do nothing but credentialing and contract negotiations yet couldn't produce one thing she was currently working on.
Friday: L and I met with the doctor this morning at 7am giving her my thoughts and proposals. I got full approval to implement all changes and firings. Yep we fired people and the one who couldn't follow directions was the 1st to go. I set up a credentialing application online that goes out to a lot of insurance companies (one stop place) and downloaded the master form into Microsoft Word and filled it out (that took me all of 30 minutes to do). All they have to do to keep it up is update the info and then I trained an underutilized girl on that. The dear doctor I am doing all this for arranged for me to get an MRI of my ankle today free of charge! She is a peach and people are just walking all over her. So I found out today what I did to my ankle. Just loverly. Now I have to work another surgery into my schedule. Anyway, mostly what I found in the ones I fired were lazy people who were taking total advantage of the doctor who had retired but had to come out of retirement when the doctors who had bought her practice ran up huge bills and then declared bankruptcy. Since she was a cosigner on the loan given to them, she had to repay the money. She currently has a lawsuit against them. She came back out of retirement and is trying to keep the practice going and believe me, it is a great practice just zippo cash flow. I have already been doing her surgery center billing and she trusts me (the prior biller brought in only 1/25th of what I made for her this past year because of stupidity and not appealing denied claims). As for the billing department: the doctor is keeping the biller but it has to be done inhouse now so her hours can be accounted for. She is only to work on the AR in her system. All new billing is coming to me. I set up the new software application then L and I trained the girls on it. It is a much easier system than the one she has and the girls were really excited about it. For right now I will do the billing but I plan on training one of the girls I really liked to do it. She was so underutilized before. I had each girl redefine their jobs with everyone. They were all introduced to each other and complimented on what they do. As for the 2 other billing girls: one was working 20+ hours a week and her only job was inputting new charges...she was fired (she has been paid 20 hours per week since May and no charges were entered into the system since May so what was she doing? Heaven only knows!); and the other was paid for 20+ hours a week to do nothing but send out statements (yet interesting enough not one dime was collected on any of those statements) and it takes my office only 2 hours a week to do the same job. I will be going through day by day their entire schedule for the past year to see what else was never even billed into their system. As I said I found the things from May that not even billed let alone the files I found that were unsubmitted. I can only imagine what else I will find for the entire year. There was another redundant employee whose only job was to clean the rooms after a patient was in it. Yeah right for $25.00 per hour for 40 hours a week to do nothing but clean rooms. That one went too. There were 2 nurses and 2 certified medical assistants there. Their new jobs are to clean the rooms themselves. Total of who lost their jobs: 5. I retrained the front office girls who have more brains than what they were doing. They are taking over some things and lessening what the OM was doing. I put them into a proactive mode rather than a reactice chaotic mode. By today when I left, there were pleases and thank yous and good employees left and a pride in the office and a comfort level that they are going to make it and not end up closing their doors. I plan on going back up within a month hopefully depending on my ankle to follow up and start some more teaching on the new software, etc so they can take billing and credentialing back in their own office. We finally left there around 4:30pm.....not a good time to drive back to Chicago right into the midst of rush hour and bumper to bumper traffic. It took us an hour and half to go up there and 3 hours to drive home. Hubs got home about an hour after me so it was me and one of my granddoggies. I decompressed, exhausted from the past 2 days, then looked for something in the frig/freezer for dinner. I scanned the mail (nothing but bills which can wait for another day). Did get the proposal though for the new roof which was about what I expected. Threw frozen marinara into a pan to thaw for dinner. Called son and had him pick up a loaf of bread to make garlic bread on his way home from work. Made mostaccoli with marinara for dinner with garlic bread and salad. Gave hubs the MRI x-rays and the report from the radiologist who read them. Then unpacked and went to bed. I am so happy I have 2 days to decompress before going back to work on Monday although I know I will be doing work for this doctor over the weekend. Just knowing though that I can do it in my robe without makeup makes me happy. Just have to convince the surgeon for my ankle to postpone it until next week so I can get things rearranged workwise to be off a week.
Wednesday: Right now I am sitting in a hotel room getting ready to do that consultant work on a doctor's office starting tomorrow. I had a full day already today with the officer manager's meeting I did from 8am to 1:30pm then went to the L office and worked there until 7pm when L picked me up to come up here. We made it up here in less time than I anticipated. We elected to have separate rooms mainly because I needed a handicapped room and those only offer 1 queen sized bed in them. Sharing a bed with another female especially one who is your employee is not good for me. I have the splint on the knee, the splint on the hand, and the cast on the ankle plus I am used to sleeping in a king sized bed and tend to do the snuggle thang. Not good if I am in a smaller bed and with an employee. Wonder if that would fall under employer sexual harrassment? Anyway, I am sitting here drinking a glass of milk going over my game plan. I can't get on the internet because the secure wireless connection wasn't working. My brain is still wired from today's activities and I can't concentrate on the book I brought to read. Called hubs and we talked for a while. The doctor called and we set up the time we were meeting for breakfast so guess I better get to bed since it is now 11pm and the alarm will go off at 5am.
Thursday: Met with the doctor for breakfast then over to the office. Met all the employees. Within the 1st 15 minutes I had a headache from the chaos of the office dynamics. So game plan changed and I decided to change what I did when. I started with handing each employee an unlined piece of paper. I then gave them the instructions that they were to write on one side what they did and on the back what they thought each other employee did. After collecting those, I spent 30 minutes with each girl and then had L do the same, taking notes all the time. That took up the entire morning. Lunch was takeout from a local burger place (and yes although I hate hamburgers, I snarfed it down because I didn't know when my next meal was going to be). Then it was time for patients. I reobserved how the patient and paperwork flow was and took notes to compare that to what it was like without patients. I thought it was chaotic before...OMG it became psychotic. It was really hard to keep myself focused when everyone around me was so disorganized and the whole flow was so disruptive. I am actually surprised they had a practice at all. I then 'became a patient' and went around experiencing what they were seeing and doing, how long wait times were, seeing what they were seeing as far as room decor, cleanliness, etc. Around 4pm I started in learning their software system and after seeing that no one really knew what reports the software they were using could produce, I called their software management people and got trained fast. I ran reports and compiled them for anaylsis later. I looked up and it was 8pm so we took off with everything and went to dinner with the doctor and office manager. Really nice place....called a supper club and decorated 50's style.....great food though and fantastic view of Lake Michigan. Right now I just got finished analyzing the data and reports which were off the wall. AR (accounts receivable) was off in outer space with most of their AR in the 120+ days. Interesting was the fact that there was no AR for the 0-30, 30-60, or 60-90. That meant that NO billing has been done for at least 3 months at all. I found this one report called the unsubmitted report which means the charges were entered into the computer but not submitted to the insurance company. Normally there should be zippo unsubmitted. The report was 22 pages long and included charges dating back to 2005. What I found most interesting though was what I had the employees do (the job description of themselves and each other employee). I found there only to be 2 employees who knew what the others were doing. The others instead of listing the names of the employees listed them instead by department letting me know they didn't even know their names. Also interesting was how they followed directions. One employee got lined paper to write hers on totally going against the instructions. Then I analyzed their handwriting which told me what I had already found out that day. Interesting things you find in handwriting analysis. I complied my observations and plan to go over with the doctor tomorrow at breakfast again at 7am. Before we left the office the doctor got an email from one of the employees...calling me a bitch and interfering and that if the doctor was going to listen to me then she was quitting. Interestingly enough she was the one who didn't follow directions and also the one who couldn't produce what she was working on and contracts the doctor was credentialed with. She just gave me excuses. Note she is paid 40 hours to do nothing but credentialing and contract negotiations yet couldn't produce one thing she was currently working on.
Friday: L and I met with the doctor this morning at 7am giving her my thoughts and proposals. I got full approval to implement all changes and firings. Yep we fired people and the one who couldn't follow directions was the 1st to go. I set up a credentialing application online that goes out to a lot of insurance companies (one stop place) and downloaded the master form into Microsoft Word and filled it out (that took me all of 30 minutes to do). All they have to do to keep it up is update the info and then I trained an underutilized girl on that. The dear doctor I am doing all this for arranged for me to get an MRI of my ankle today free of charge! She is a peach and people are just walking all over her. So I found out today what I did to my ankle. Just loverly. Now I have to work another surgery into my schedule. Anyway, mostly what I found in the ones I fired were lazy people who were taking total advantage of the doctor who had retired but had to come out of retirement when the doctors who had bought her practice ran up huge bills and then declared bankruptcy. Since she was a cosigner on the loan given to them, she had to repay the money. She currently has a lawsuit against them. She came back out of retirement and is trying to keep the practice going and believe me, it is a great practice just zippo cash flow. I have already been doing her surgery center billing and she trusts me (the prior biller brought in only 1/25th of what I made for her this past year because of stupidity and not appealing denied claims). As for the billing department: the doctor is keeping the biller but it has to be done inhouse now so her hours can be accounted for. She is only to work on the AR in her system. All new billing is coming to me. I set up the new software application then L and I trained the girls on it. It is a much easier system than the one she has and the girls were really excited about it. For right now I will do the billing but I plan on training one of the girls I really liked to do it. She was so underutilized before. I had each girl redefine their jobs with everyone. They were all introduced to each other and complimented on what they do. As for the 2 other billing girls: one was working 20+ hours a week and her only job was inputting new charges...she was fired (she has been paid 20 hours per week since May and no charges were entered into the system since May so what was she doing? Heaven only knows!); and the other was paid for 20+ hours a week to do nothing but send out statements (yet interesting enough not one dime was collected on any of those statements) and it takes my office only 2 hours a week to do the same job. I will be going through day by day their entire schedule for the past year to see what else was never even billed into their system. As I said I found the things from May that not even billed let alone the files I found that were unsubmitted. I can only imagine what else I will find for the entire year. There was another redundant employee whose only job was to clean the rooms after a patient was in it. Yeah right for $25.00 per hour for 40 hours a week to do nothing but clean rooms. That one went too. There were 2 nurses and 2 certified medical assistants there. Their new jobs are to clean the rooms themselves. Total of who lost their jobs: 5. I retrained the front office girls who have more brains than what they were doing. They are taking over some things and lessening what the OM was doing. I put them into a proactive mode rather than a reactice chaotic mode. By today when I left, there were pleases and thank yous and good employees left and a pride in the office and a comfort level that they are going to make it and not end up closing their doors. I plan on going back up within a month hopefully depending on my ankle to follow up and start some more teaching on the new software, etc so they can take billing and credentialing back in their own office. We finally left there around 4:30pm.....not a good time to drive back to Chicago right into the midst of rush hour and bumper to bumper traffic. It took us an hour and half to go up there and 3 hours to drive home. Hubs got home about an hour after me so it was me and one of my granddoggies. I decompressed, exhausted from the past 2 days, then looked for something in the frig/freezer for dinner. I scanned the mail (nothing but bills which can wait for another day). Did get the proposal though for the new roof which was about what I expected. Threw frozen marinara into a pan to thaw for dinner. Called son and had him pick up a loaf of bread to make garlic bread on his way home from work. Made mostaccoli with marinara for dinner with garlic bread and salad. Gave hubs the MRI x-rays and the report from the radiologist who read them. Then unpacked and went to bed. I am so happy I have 2 days to decompress before going back to work on Monday although I know I will be doing work for this doctor over the weekend. Just knowing though that I can do it in my robe without makeup makes me happy. Just have to convince the surgeon for my ankle to postpone it until next week so I can get things rearranged workwise to be off a week.
Saturday, September 15, 2007
Ankle Update
There are 3 different kinds of ankle sprains. The severity of the ankle sprain depends on how much you turned your foot in or out. The forces put on the ligaments to turn it in or out cause the ligaments to stretch beyond their normal limits. If the force is too strong, the ligaments can tear.
The amount of force determines the grade of the sprain.
Grade 1 sprain: Slight stretching and some damage to the fibers (fibrils) of the ligament. You would have minimal swelling and tenderness. It doesn't impair your activities much. Treatment would be RICE (rest, ice, compression, elevation) and usually you are fine within a week or 2.
Grade 2 sprain: Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, abnormal looseness (called laxity) of the ankle joint occurs. You will have moderate swelling and tenderness and won't be able to move your ankle very well. You might be moderately impaired (crutches, removable or soft cast, etc). Usually you are find within a month.
Grade 3 sprain: Complete tear of the ligament. If the examiner pulls or pushes on the ankle joint in certain movements, major instability occurs. There is a lot of swelling and tenderness and you might be totally unable to stand on your foot at all. Treatment consists of total immobilization (walking cast) for up to 6 weeks then gradual physical therapy to strengthen the ligaments.
There is actually one worse than Grade 3 - they call these the high ankle sprains and tend not to heal as well. If the injury seems stable, then a non-weight bearing cast for 6 weeks followed by more testing for healing and stability then physical therapy. If the ankle is unstable treatment is again treated in a non-weight bearing cast for 6 weeks. If it remains unstable, then a 'syndesmotic screw' has to be placed between the tibia and fibula to hold the bones in proper position while the syndesmotic ligaments heal. You are placed in a non-weight bearing cast for 3 months. If you walk on the leg/foot at all, the screw will break. At 3 months, another MRI will determine if the screws can be removed. If they can, then you go into a weight bearing cast for another 6-8 weeks then intensive physical therapy to relearn how to walk.
I had the MRI yesterday. I have an unstable grade 3 sprain high ankle sprain along with a complete rupture of most of the major ligaments in the foot and ankle which allows one to be able to stand and walk. So I will need surgery and lucky me to get screwed not once but twice (2 screws) along with suturing or repairing the ends of the ruptured ligaments together then reinforcing them with what is called a GraftJacket. At the end of the 3 months I get to go for another surgery if the MRI says I have healed I get to be unscrewed. I might be able to walk with a cane by the time of my daughter's wedding in May. If the MRI doesn't show any healing of the syndesmotic tears I will have to have my ankle fused together and that takes 6 months of non-weight bearing to heal and I will never be able to move my ankle again.
Not a happy camper right now.
The amount of force determines the grade of the sprain.
Grade 1 sprain: Slight stretching and some damage to the fibers (fibrils) of the ligament. You would have minimal swelling and tenderness. It doesn't impair your activities much. Treatment would be RICE (rest, ice, compression, elevation) and usually you are fine within a week or 2.
Grade 2 sprain: Partial tearing of the ligament. If the ankle joint is examined and moved in certain ways, abnormal looseness (called laxity) of the ankle joint occurs. You will have moderate swelling and tenderness and won't be able to move your ankle very well. You might be moderately impaired (crutches, removable or soft cast, etc). Usually you are find within a month.
Grade 3 sprain: Complete tear of the ligament. If the examiner pulls or pushes on the ankle joint in certain movements, major instability occurs. There is a lot of swelling and tenderness and you might be totally unable to stand on your foot at all. Treatment consists of total immobilization (walking cast) for up to 6 weeks then gradual physical therapy to strengthen the ligaments.
There is actually one worse than Grade 3 - they call these the high ankle sprains and tend not to heal as well. If the injury seems stable, then a non-weight bearing cast for 6 weeks followed by more testing for healing and stability then physical therapy. If the ankle is unstable treatment is again treated in a non-weight bearing cast for 6 weeks. If it remains unstable, then a 'syndesmotic screw' has to be placed between the tibia and fibula to hold the bones in proper position while the syndesmotic ligaments heal. You are placed in a non-weight bearing cast for 3 months. If you walk on the leg/foot at all, the screw will break. At 3 months, another MRI will determine if the screws can be removed. If they can, then you go into a weight bearing cast for another 6-8 weeks then intensive physical therapy to relearn how to walk.
I had the MRI yesterday. I have an unstable grade 3 sprain high ankle sprain along with a complete rupture of most of the major ligaments in the foot and ankle which allows one to be able to stand and walk. So I will need surgery and lucky me to get screwed not once but twice (2 screws) along with suturing or repairing the ends of the ruptured ligaments together then reinforcing them with what is called a GraftJacket. At the end of the 3 months I get to go for another surgery if the MRI says I have healed I get to be unscrewed. I might be able to walk with a cane by the time of my daughter's wedding in May. If the MRI doesn't show any healing of the syndesmotic tears I will have to have my ankle fused together and that takes 6 months of non-weight bearing to heal and I will never be able to move my ankle again.
Not a happy camper right now.
Subscribe to:
Posts (Atom)