This was a pretty interesting week.
We had a lot of change ups in training and also work seemed to demonstrate some changes.
Work first since it pays for all the fun! On Wednesday we got our “records request” from the Centers for Medicare/Medicaid Services. I spent the day trying to figure out where the second half of the request was. It was buried in the packet that the manager of “Health Information Management” had not really looked at. It took about 6 hours of my 8 hour work day to unravel that, but I did. I was a wee bit annoyed, but really…this is why they pay me- in part- to be sure that stuff gets done correctly.
Oddly. CMS has asked for 2 charts to review for Surgical Site Infection, and neither of the 2 patients they chose had a surgical site infection. Both arrived at the hospital with nasty infections due to perforated bowels, both were discharged from the hospital within 5-10 days with no further visits returns or complaints. So, I’ll be curious as to what the chart reviews of those two cases reveals. I think it will reveal that their system of using coding to identify things is not very accurate. (Yes both patients had an “infection related code” but even the coders clearly noted “Present on admission”).
To add to my anxiety: CMS is validating the Laboratory ID reporting I do to the CDC. CDC reporting is very focused on Location based lab testing. CMS is focused on “billing status” As in: was the patient considered inpatient, observational, or outpatient. CDC just cares where the patient was physically in the building. I have no idea how CMS will judge or validate. I could do very well, if they validate on the CDC standards, or I could fail entirely if they interpret the CDC guidelines differently.
Anyway, the rest of the week, I have been pleasantly surprised at how easy to CDAC (Clinical Data Abstraction Center) has been to work with- in comparison to both CMS and CDC. I sent them some examples of documentation for validation and they immediately replied that this was the appropriate documentation that they wished to see. Usually, when dealing with Government I hear…. “We can not tell you what is or is not acceptable, only you can decide what is appropriate”….But CDAC help desk was very forthcoming and honest. I told the help desk woman in York PA that she was 20 mins from my hometown to which she replied that I should come visit any time I’m back home. This was much friendlier and I appreciated it. I will go visit, if only to see the building and people who have caused me such angst.
SO, looks like we will soon have the records copied and sent off, and then I sit and stew until about Mid-July when I receive an arbitrary score…based on…I mean, they are supposed to be checking how accurate I am with my reporting, but they chose 2 patients who did not even have any infections….etc. I say this because I do feel that the reporting on websites such as “Hospital Compare” doesn’t actually often reflect anything current or truthful about the quality of care provided at any hospital. I know they are trying, but…current data on the website is about 1 -2 years old as it is.
So, I may survive this validation process. This is the tail end of round one. I have 2 more quarters to go after this.
BUT….What is life without training? Mine would be kinda empty.
Monday I had off for Memorial Day. THis is a huge change for working out, as loads of people did not work on memorial day.
The gym and pool were closed, so I headed out to Lucky’s Lake.
I was essentially supposed to do the distance that equalled 3 crossings. I don’t know what got into me, but I just did one. I was tired. Plus, I got a lot of water up my nose which gave me quite a bit of pause. I let coach man know and he didn’t seem to care about the lack of distance. I did not bother him about my amoeba fear, I mean if I get it I’m just gonna pretty much die. I did have the thought that if I had amoeba, I would not have to worry at all about reporting requirements, ha ha ha I think I’m out of the amoeba window for now.
Tuesday I went back to work and training.
4 mile tempo run which was WOW…really BAD! I had one mile at projected tempo pace. Mile number 2 I could not hold pace at ALL. Usually mile 2 is an easy fast mile, but not today. At the end of mile 2 I regrouped and thought I would “jog home” but actually Mile 3 ended up being quite fast. Mile 4 has some rather large hills at the end and so it also ended up being like Mile 2. I hate hated this run. So frustrating. Post work, I had a legs workout and a swim. The legs workout went pretty well and the swim was awesome…my own lane on a tuesday evening. My friend was supposed to swim with me but she cancelled, which really didn’t affect me…I’m always going to get my workouts done.
Wednesday I had a Brick.
Unlike many, I like me some brick. This one was a simple 35 min spin and a 3 mile run. because of Tuesday’s fail, I felt pretty hesitant. I saw my friend in the locker room between the bike and run….(so yes transition was extended for shoe change bathroom, and chit chat. well, I’m not really a triathlete!). I moaned a bit and one of the professional triathletes grinned madly at me, as I was already pretty sweaty as I said, “I’m a just gonna do a little itty run out there…” The run turned out FINE. I think the spin loosened up my hip. It was more of a tempo run than my tempo run. I was definitely aware of the hot hot hot and muggy humid conditions, but somehow I just ran through them…Hope this is the start of a summer of just getting through, which would be loads and I mean LOADs better than last summers Moan and Whine festival.
Thursday: Speed work on the treadmill. I could have done this outside, but chose the TM for flatness and also for the air conditioning. (No joke there.) 2 sets of 2 mile repeats. This is a bit gentler than 800 repeats. I had a bit of trouble deciding what speed to take them at. I was afraid to commit to a speed that I “Should” be doing them at, because I wanted to be able to complete the repeats. So…they may have ended up slower, but that’s what I did. The 2 mile repeats is really a tricky workout..Start out too fast…and somewhere you fail…start too slow and you feel like a total slug that didn’t push it. I feel Ok about these, I’m in a build period and still trying to get it together with the speed work. Whatever.
Thursday Night I did some arms and abs and hung around with the Coach. We had some good discussion about the repeats, and things in general. He is such a good influence on my life. I hope we continue in the vein we have been in recently. Coaching relationships, like any other relationship can have ups and downs and can be quite intense.
Friday I had another Brick. 50 min cycle and 7 mile run. Yes, that is not a typical brick, but I’m not a triathlete. The purpose of a brick for me is to get used to running on tired legs. My legs were tired, but I was so glad to be getting it done on a Friday. It did make for a bit of a “low motivation” day at work. This was the second switch, it was in order to get me on the run at 6 am rather than at 8 am, makes a big difference right now with the heat.
Saturday was a blast. because of our switch- I got up late, hung around the house, piddled about…and eventually made my way over to the gym for a long long swim. 2 miles of swimming later, I inhaled some pizza, and rested, still feeling like I had done an easier workout than normal…(I did Friday’s workout, plus a few more yards.)
Today I had the “long” run. 12 miles again. I tried out Chia seeds in my nutrition, and added in an extra salt stick cap. I also forced myself to intake more liquid than I wanted. I think as I get warm, my interest in drinking or eating goes down, but if I decrease my intake, well… It seems to have worked pretty well. I did not get miserably chilled like last week after, and my run was slightly faster than last week, on the same route despite starting later.
So overall feeling pretty good. My one current work/life balance obstacle is this exam I am supposed to be studying for. I take it in July. I periodically pull out index cards, but honestly…I do not want to study. So lets hope I pass it in July because if I do not, I will be studying until October when I will have to retake it and hopefully pass.
Overall a good training week. Only 6 more hard days then I get a rest week…which is a diet week, and a study week too.
Today of course is Comrades Marathon day. So training seems to have taken on a new appeal.