S02.E14 Sabbath

[Whimsy]

Quote

Max races against the clock to rearrange the budget when faced with employees going unpaid. Kapoor is presented with a device that's the future of medicine. Iggy goes against the norms to prove a diagnosis. Bloom gets an unexpected visitor.

Original airdate 2/18/2020

[ams1001]

Um...I don't think cutting $2M on paper today actually gives you $2M to cash out in paychecks tomorrow.

 

[nixgirl28]

Why do I watch this show? It's beyond ridiculous!

[ams1001]

14 minutes ago, nixgirl28 said:

Why do I watch this show? It's beyond ridiculous!

I ask myself that every week! (I actually didn't finish watching the last 20 minutes or so of last week's.)

I do like the ex-military guy (I forget what his actual position is now) following Max around. He's a nice little bit of comic relief.

Edited February 19, 2020 by ams1001

[preeya]

2 hours ago, ams1001 said:

Um...I don't think cutting $2M on paper today actually gives you $2M to cash out in paychecks tomorrow.

It can't. Crossing out a line item in the budget book doesn't put any real money in the banking system.

IMO, Gina Gershon & Janet Montgomery could really pass for mother & daughter. Quite a striking resemblance.

[LittleIggy]

Todd was the highlight of the show. We need more Todd!

I really don’t understand the thing about the girl passing a tapeworm to her mother through a kiss. Were they French kissing? 🤢

How is sharing a meal and apparently having a good time less guilt-inducing than going to a play? Seemed much more intimate to me.

[apn85]

2 hours ago, LittleIggy said:

Todd was the highlight of the show. We need more Todd!

How is sharing a meal and apparently having a good time less guilt-inducing than going to a play? Seemed much more intimate to me.

I do love Todd! 😂 and "Sandra Fall from Billing"

I didn't understand the whole date thing either. Watching a show & not having to talk a lot vs. sharing a meal where all you do is talk.....🤷‍♀️ I think this will be Max's relationship to get him through the guilt and baggage he's dealing with as a widower and he'll probably help her in the same way. I still don't see a big, longterm romance though. I think it's a means to an end, but that is just me. 

I'm ready for this Castro thing to finally blow up. Every week it seems they add a little more to it. 

I did read that this episode was directed by Ryan Eggold. Thought that was neat! 

Edited February 19, 2020 by apn85

[TVForever]

6 hours ago, LittleIggy said:

Todd was the highlight of the show. We need more Todd!

How is sharing a meal and apparently having a good time less guilt-inducing than going to a play? Seemed much more intimate to me.

I figured it had something to do with her dead husband being a musician and his dead wife being a dancer. Maybe going to a show (and enjoying it with someone else) would bring up their memories in an uncomfortable way.

Sharing a meal and talking is more  2 new friends just hanging out and getting to know each other better. Fewer ghosts in the room.

[Madding crowd]

So insurance companies are ok with patients being flown to Mexico to have surgery? What if they didn’t have passports or were too sick to fly? More and more surgeries are being done at surgery centers which is how Joan Rivers died because they are not equipped to handle cardiac or brain emergencies. 

I still like Max, fantasy doctor that he is.

[preeya]

3 hours ago, Madding crowd said:

More and more surgeries are being done at surgery centers which is how Joan Rivers died because they are not equipped to handle cardiac or brain emergencies. 

I've had three procedures (minor) at surgery centers. It's like being at a car wash. Prep, surgery, post op review, dismissed. This works well for routine in and out stuff. The "big stuff" (like open heart) should be done in a hospital setting with all necessary life-saving procedures in place.

ETA: I don't think health insurance covers travel to foreign countries.

ETA2: A second thought, the center where I had my procedures done is actually in walking distance to a major hospital.

Edited February 19, 2020 by preeya

[Madding crowd]

Yes I have had three procedures done at surgery centers. If something goes wrong, they need to call an ambulance and take you to a hospital. It is obviously not ideal for cardiac procedures, even routine ones.

[SunnyBeBe]

I was impressed by DAWN.  lol  I'm quite curious about the new cardiac doctor that might be coming aboard.  She might add some interest. 

 

[doodlebug]

3 hours ago, Madding crowd said:

So insurance companies are ok with patients being flown to Mexico to have surgery? What if they didn’t have passports or were too sick to fly? More and more surgeries are being done at surgery centers which is how Joan Rivers died because they are not equipped to handle cardiac or brain emergencies. 

I still like Max, fantasy doctor that he is.

No, insurance companies would not be paying the tab for sending patients to Mexico.  For that matter, many insurance companies don't provide coverage for medical care given outside the country, so people who go to Mexico for surgery are those who either have no insurance or have huge deductibles and the cost of the trip and surgery done there is still cheaper than the out of pocket at a US hospital.  As usual, this show totally doesn't understand how health care works.  Also, unless New Amsterdam was providing that care to patients for free, there was no cost savings to the hospital for farming the procedures out to Mexico anyway. If anything, it would cause New Amsterdam to lose income while increasing expenses, presuming they were footing the bill for the flights.

As many, many others have noted, cutting $2million from the annual budget does absolutely nothing to provide enough immediate funding to meet payroll.

New Amsterdam's clinic to provide postpartum care to undocumented women is hardly necessary, either.  Undocumented women go to regular hospitals and clinics for prenatal and postpartum care without much concern. They are undocumented which means that, if they can't or won't pay for their care, there is no way anyone is going to be able to find them to collect anyway.  There are women from developing nations who come to the US and give birth and the reason that many of them don't seek maternity care is cultural, not financial.  They come from a place where services like prenatal care, blood work, ultrasounds, hospital birth and postpartum maternal and pediatric care are not common or readily available to the poor.   They don't get these services in the US because they don't realize they need them or that they are beneficial.

And, yes, the only way to transmit tapeworms orally is to share saliva containing the eggs.  I don't know many mother-daughter combos who swap spit while kissing.  The severity and rapid progression of the mother's symptoms was also unrealistic.

This show is just so poorly written and much of it makes no sense.

[dotdot]

As unrealistic as the show is, I still enjoy it. I look at it just as a "feel-good" show with characters genuinely caring about their patients (and each other for the most part) trying to do the right thing to help, in spite of big insurance companies, cracks in the system, etc. There is usually a happy outcome (even if it's in a totally illogical, infeasable way). A nice break from "real-world" for an hour. I can see though, if I worked at a hospital or had more understanding of the inner-workings of the medical field how it might drive me crazy.

[ams1001]

If the daughter gave mom the tapeworm, why wasn't the daughter sick? Did they say anything about testing/treating her?

[Aliconehead]

5 hours ago, Madding crowd said:

So insurance companies are ok with patients being flown to Mexico to have surgery? What if they didn’t have passports or were too sick to fly? More and more surgeries are being done at surgery centers which is how Joan Rivers died because they are not equipped to handle cardiac or brain emergencies. 

I still like Max, fantasy doctor that he is.

While not the same thing, this article talks about Mexico being used to reduce us health care expenses. So not out of realm of possibility. Also, I know that UCSD Shiley Eye center has sent patients to Mexico for care

  https://abcnews.go.com/Health/wireStory/utah-sends-employees-mexico-lower-prescription-prices-68861516

[auntiemel]

17 hours ago, ams1001 said:

Um...I don't think cutting $2M on paper today actually gives you $2M to cash out in paychecks tomorrow.

 

I was just coming here to post this! 😂

[Dowel Jones]

Max's great idea at the end doesn't make a lot of sense either.  Farm your doctors out to the hinterlands?  Is that what he's saying? Because charging another hospital the traveling doctor's salary, even with an admin charge, isn't going to increase revenues, because it's just a pass through charge.  Is he advocating bringing those patients to New Amsterdam?  Who pays for that?

Janet Montgomery' accent slipped just a bit in one scene (in the hallway) where she yelled at her mother.  She said something like "Patients not allowed in this area."  Problem is, she used the English 'arear', as she is native to London.  That's okay.

I do like Max finally getting blindsided about his chief of cardio leaving.  Pay attention to your people, Max.

Too bad Todd wasn't around last week when the hospital sunk all their loose change into a hospice ward.

 

Edited February 20, 2020 by Dowel Jones

[Emma9]

And why did Kapoor have to specify that the eggs were transmitted via a kiss? Not possibly taking a drink out of the same glass or something?

Max siding with the DAWN program was a delightful bit of hypocrisy considering his previous stance on any screens being allowed to taint patient interactions. (But if the inventors of that program have invented language recognition/translation software sensitive enough that the Hungarian woman could have a coherent conversation with it regarding her symptoms and treatment, they don't need to dabble in the medical field, they could make a fortune off that aspect alone.)

~

So the takeaway here is, Max has finally and completely burned through New Amsterdam's budget, there isn't one item that could be feasibly be trimmed from any department, various doctors are going to be schlepping around to other facilities (are they going to get any additional compensation for the extra trouble, and/or time away from their families?) to just cover the current shortfalls, and any future bright ideas/programs being implemented are going to require another program of equal cost being cancelled.

Yep, I bet we're absolutely going to see that happening! [/s]

(The lend-a-specialist notion itself might make for some interesting storylines, one of the main cast being split from the show proper for an episode to treat several patients at another random hospital.)

[txhorns79]

I was a little confused about Iggy's diagnosis of the kid.  It seemed like the situation was much more complicated than "racism caused a tumor!"  I thought the kid's problem was less racism, and more that he didn't know how to deal with his feelings concerning unpleasant or hostile interactions.   It seemed to me that his preferred method of burying his feelings was the main problem, rather than the circumstances causing his hurt feelings. 

8 hours ago, Aliconehead said:

While not the same thing, this article talks about Mexico being used to reduce us health care expenses. So not out of realm of possibility. Also, I know that UCSD Shiley Eye center has sent patients to Mexico for care

I'm sure it happens, just not like it did on this show, where it seemed like everything was last minute and no one seemingly had really planned out how it would work if there was a medical emergency down there. 

 

20 hours ago, apn85 said:

I'm ready for this Castro thing to finally blow up. Every week it seems they add a little more to it. 

The way the character is being written, I'm seriously expecting someone to accidentally stumble into a secret backroom where she has stuffed the bodies of all the cancer patients she has murdered in furtherance of her study. 

[ams1001]

9 minutes ago, txhorns79 said:

I was a little confused about Iggy's diagnosis of the kid.  It seemed like the situation was much more complicated that "racism caused a tumor!"  I thought the kid's problem was less racism, and more that he didn't know how to deal with his feelings concerning unpleasant or hostile interactions.   It seemed to me that his preferred method of burying his feelings was the main problem, rather than the circumstances causing his hurt feelings. 

 

I am, admittedly, no mental health professional, and I don't discount the impact being of a minority race can have on a kid, but I feel like suggesting that every time anyone treats him in any way badly or unfairly is because of the color of his skin is probably not the way to go. (I don't doubt the kid would have experienced racism, but sometimes people really are just jerks, or don't like you for some other reason.) Plus, that whole scene felt very after-school-specially.

[txhorns79]

3 minutes ago, ams1001 said:

I am, admittedly, no mental health professional, and I don't discount the impact being of a minority race can have on a kid, but I feel like suggesting that every time anyone treats him in any way badly or unfairly is because of the color of his skin is probably not the way to go. (I don't doubt the kid would have experienced racism, but sometimes people really are just jerks, or don't like you for some other reason.) Plus, that whole scene felt very after-school-specially.

It felt like they were trying to deal with a complicated problem as though the answer was easy and obvious.  I understand the limits of network television, and I know in real life, an actual doctor would spend more than five minutes with a patient before offering a diagnosis, but I'm with you.  Maybe every negative interaction this kid seemingly has stems from racism, but the plot did not allow for any nuance and that was a shame.  

[Dowel Jones]

Not to mention the fact that, even with a proper code, insurance companies are not going to line up to say "Sure, we'll pay for that."

[LittleIggy]

5 hours ago, Dowel Jones said:

Max's great idea at the end doesn't make a lot of sense either.  Farm your doctors out to the hinterlands?  Is that what he's saying? Because charging another hospital the traveling doctor's salary, even with an admin charge, isn't going to increase revenues, because it's just a pass through charge.  Is he advocating bringing those patients to New Amsterdam?  Who pays for that?

 

I figured they were going to institute tele-medicine. The NA doctors would consult with rural hospitals through teleconferencing.

[auntiemel]

OK, I just came up with an idea about the whole budget/payroll thing came about. I don't think the whole "8 hour deadline to cut two million or people don't get paid tomorrow" thing was real.

I think what actually happened was that the marine was told to get Max to cut two million by the end of the day, and to say whatever he had to to get that done. The marine, having met Max before, correctly predicted that he would not even question the payroll thing, so that was the lie he went with. 🤣

[bros402]

On 2/18/2020 at 10:22 PM, nixgirl28 said:

Why do I watch this show? It's beyond ridiculous!

To me, it's like Scorpion but with medicine, which is the best way to think of it.

It would be amazing if it go to the Saturday Morning Cartoon level of Ridiculousness(tm) that Scorpion was at by the end.

1 hour ago, LittleIggy said:

I figured they were going to institute tele-medicine. The NA doctors would consult with rural hospitals through teleconferencing.

I also interpreted it as NA establishing a telemedicine service that they will contract out.

[doodlebug]

10 hours ago, bros402 said:

To me, it's like Scorpion but with medicine, which is the best way to think of it.

It would be amazing if it go to the Saturday Morning Cartoon level of Ridiculousness(tm) that Scorpion was at by the end.

I also interpreted it as NA establishing a telemedicine service that they will contract out.

Telemedicine services are tremendously difficult to bill and get reimbursement.  Insurance companies just don't consider telemedicine to be a legitimate means to provide medical care in many, if not most, cases.

I work for a huge hospital system, very well known internationally.  We have the ability to do virtual visits with patients.  Do you know what services we are specifically encouraged to provide?  Things like prenatal care and post operative visits.  Why? Because most insurance companies pay a global fee for these services.  When a pregnant woman goes to the doctor or midwife, nothing gets billed until the birth has happened.  And, then, the payment is a lump sum and doesn't depend on the number of prenatal visits she has.  Therefore, if a pregnant woman does a couple of online visits, there are slots opened up in the doctor's schedule for paying patients.  Same thing with surgical patients.  It's a global fee situation, the pre-op and post-op visits are not paid for as specific entities and so, keeping those patients off the regular office schedule gives more room for patients who aren't getting bundled services.

So, any facility using New Amsterdam docs via Skype, etc, would have to find another way to pay those doctors for their services.  Now, sometimes a big hospital might contract to provide the services in return for transferring complicated patients to their facility, but it is not always fiscally reasonable.  And most smaller hospitals have the sort of cash flow problems that New Amsterdam has.  I doubt that a patient with a complicated problem is going to choose a specific remote small hospital just because that hospital can get a specialist on line to consult.  It's not a selling point for most patients.

Edited February 20, 2020 by doodlebug

[bros402]

13 hours ago, doodlebug said:

Telemedicine services are tremendously difficult to bill and get reimbursement.  Insurance companies just don't consider telemedicine to be a legitimate means to provide medical care in many, if not most, cases.

I work for a huge hospital system, very well known internationally.  We have the ability to do virtual visits with patients.  Do you know what services we are specifically encouraged to provide?  Things like prenatal care and post operative visits.  Why? Because most insurance companies pay a global fee for these services.  When a pregnant woman goes to the doctor or midwife, nothing gets billed until the birth has happened.  And, then, the payment is a lump sum and doesn't depend on the number of prenatal visits she has.  Therefore, if a pregnant woman does a couple of online visits, there are slots opened up in the doctor's schedule for paying patients.  Same thing with surgical patients.  It's a global fee situation, the pre-op and post-op visits are not paid for as specific entities and so, keeping those patients off the regular office schedule gives more room for patients who aren't getting bundled services.

So, any facility using New Amsterdam docs via Skype, etc, would have to find another way to pay those doctors for their services.  Now, sometimes a big hospital might contract to provide the services in return for transferring complicated patients to their facility, but it is not always fiscally reasonable.  And most smaller hospitals have the sort of cash flow problems that New Amsterdam has.  I doubt that a patient with a complicated problem is going to choose a specific remote small hospital just because that hospital can get a specialist on line to consult.  It's not a selling point for most patients.

Oh yeah, I know telemedicine isn't usually covered by insurance - but maybe Magic Max will make it so every insurance company will cover New Amsterdam's Skype Medicine Shack 😛

Yeah, I have a complicated medical history and I would never go to a rural hospital because they have telemedicine with some big name hospital

[Johnny Dollar]

Sorry show, but that’s not how budgets work. Max can institute all the new programs he wants, but if his budget doesn’t include a way to pay for them, then the programs go away. And cutting future costs or counting on future revenue to pay today’s expenses doesn’t make cash magically appear.

Why do both the head of the hospital and the head of the neurology department not know that a company is paying $160,000 for the neurology department to use new diagnostic tools?  Who’s signing off on this stuff?

So the mother caught a tapeworm from her daughter. Wouldn’t the mother’s symptoms indicate that she may have a tapeworm without her having to die first?  Aren’t there ways to detect tapeworms, like stool samples and blood tests? If DAWN can speak Hungarian, she/it should certainly be able to come up with that diagnosis. They make these people out to be miracle workers with these last minute, life saving treatments, but in reality they’re just incompetent.

I’m going to go out on a limb and say that no insurance company is going to pay for procedures performed in Mexico. These people would be sued into bankruptcy for that stupid stunt.

Sorry Iggy, but racism is not a diagnosis.  It may be a contributing factor to that kid’s anxiety, but it’s no more a diagnosis than having a dictatorial boss would be for someone suffering from job related stress. Your job, in case you forgot, is to help the patient develop ways for dealing with those stressors.

Max, your great specialists, who can’t even detect a simple tapeworm infection or know that having a blood bank available might be a good idea, may not be in such demand in Podunk, Delaware as you think. There are medical schools and teaching hospitals all over the country with many, many fine specialists that might be a little more convenient sources of care than your dump where you’re not even sure if you can make payroll from week to week. And someone needs to teach you about how insurance works if you think getting rid of mammograms is a good idea.

Other than that, the show was spot on real this week 🙄🙄

[LittleIggy]

Why is the Head of Neurology down in the ED on what seem like random cases? This has happened with other department heads too. It’s like the head partner of a law firm handling traffic cases. 

[Guest]

I thought to myself “and that, Max, is why you don’t constantly blow it off when the board asks you to meet with donors!”

[bros402]

13 hours ago, LittleIggy said:

Why is the Head of Neurology down in the ED on what seem like random cases? This has happened with other department heads too. It’s like the head partner of a law firm handling traffic cases. 

Maybe Kapoor was bored, or maybe someone called for a neuro consult and he was like "oh i better get down there so Max doesn't think I don't want to interact with patients!"

[alexvillage]

On 2/19/2020 at 12:43 AM, preeya said:

It can't. Crossing out a line item in the budget book doesn't put any real money in the banking system.

On the other hand, I actually cheered when Max made the decision, since my main complaint with this show is how they present real problems but come up with impossible, unrealistic solutions. Budget cuts happen often and for once I thought that the conclusion would be a little closer to a real outcome. But nope. Didn't happen.

 

On 2/19/2020 at 9:14 AM, Madding crowd said:

So insurance companies are ok with patients being flown to Mexico to have surgery? What if they didn’t have passports or were too sick to fly?

Passports: it is New Amsterdam, so don't dwell to much on logistics.

The insurance part might be the writers picking up on something that is actually happening, insurance companies paying people to fly to Mexico and fill up their prescription, plus giving them 500.00 because it is cheaper than the prescription in the US. As far as paying for actual procedures, that would be a totally different thing. 

[SnarkySheep]

On 2/19/2020 at 11:19 PM, txhorns79 said:

Maybe every negative interaction this kid seemingly has stems from racism, but the plot did not allow for any nuance and that was a shame.  

IMO it was more like Iggy decided racism was the root problem, then pushed the idea onto both the boy and mom without any real evidence.

How, for instance, does Iggy KNOW the librarian was acting out of racism? Perhaps the books in question are needed by the honors class for a specific project, and if a kid who doesn't actually need them checks them out, they won't be available for them. Are all the honors students white? Did any other non-honor student want the books but was denied? If so, what race were they? etc. 

You all see my point, I'm sure...

 

[LittleIggy]

Naming the kid “Cephus” didn’t help.