[rjflyn]

No the LTC needs to be treating the pt for the stuff the pt has had for the last 3 weeks where they are instead of sending the pt to the ER at 3PM on Friday afternoon.

Almost everyone gets a UA/urine culture done as it is now. We are limiting the amount of foley's we put in pt's, the floors whine every time we give report by the way. I don't know what I give more of Vicodin or Rocephin; Percocet or Avelox.

I know where we use to have maybe one or two dx per pt when we did the discharge paperwork it averages 4 plus now.

Rj

[suanna]

Originally Posted by ksilty

Sorry, I don't get your point... You're saying we should ignore the situation (MRSA, etc), hoping they'll be diagnosed somewhere else?

My point- not paying for care given to a patient as a solution to the rise of resistant organisms is political idiocy! The thinking is "infections are costing us too much- lets just not pay for treating them!!!" Hospitals are forced to expend resources and staff that already are strained to the limit to prove "we didn't give them this bug" so we can be paid for treating it. We get paid if the patient came in with it. Screening is great if you have the staff and resources, esp if it is for the benifit of the patients. Better staffing, education, monitoring for compliance, equipment changes,.... to solve the problem would be what I would prefer. The screening we are doing is to provide for billing/payment.

[suanna]

Originally Posted by ksilty

Sorry, I don't get your point... You're saying we should ignore the situation (MRSA, etc), hoping they'll be diagnosed somewhere else?

My point- not paying for care given to a patient as a solution to the rise of resistant organisms is political idiocy! The thinking is "infections are costing us too much- lets just not pay for treating them!!!" Hospitals are forced to expend resources and staff that already are strained to the limit to prove "we didn't give them this bug" so we can be paid for treating it. We get paid if the patient came in with it. Screening is great if you have the staff and resources, esp if it is for the benifit of the patients. Better staffing, education, monitoring for compliance, equipment changes,.... to solve the problem would be what I would prefer. The screening we are doing is to provide for billing/payment.

[ZippyGBR]

Originally Posted by jlsRN

Many healthy people are positive for MRSA, but not infected. Are we going to have these people in full isolation? Will they all be getting Vanco? What will we be doing with this information other then documenting it?

skin or Upper resp tract carried?

skin carried- skin eradication regime doesn't need isolation unless they have a nasty dry skin condition - i forget what the active ingredient in the washing product is - but the regime is to wash with that instead of soap / shower gel / shampoo for five days including at least 2 hair washes...

upper resp tract - again elimination regime and isolation if required - bactrobon ointment is in outr eradication guideline

carriers of MRSA don't need Vanc - treating an infection that isn't there one of the great failures of US healthcare ( notice no one else in the world using topical antibiotics on none infected wounds and sticking plasters in europe are generally 'unmedicated')

[jyoung1950]

I work in the ICU at our hospital and we swab on admission, on discharge and every Tuesday morning we swab all the patients.

[ksilty]

Originally Posted by suanna

My point- not paying for care given to a patient as a solution to the rise of resistant organisms is political idiocy! The thinking is "infections are costing us too much- lets just not pay for treating them!!!" Hospitals are forced to expend resources and staff that already are strained to the limit to prove "we didn't give them this bug" so we can be paid for treating it. We get paid if the patient came in with it. Screening is great if you have the staff and resources, esp if it is for the benifit of the patients. Better staffing, education, monitoring for compliance, equipment changes,.... to solve the problem would be what I would prefer. The screening we are doing is to provide for billing/payment.

Are you saying a payer will not pay for a HAI if the patient is in the contact facility. Sorry, I still don't understand. I am reading that a facility will get paid if the infection is pre-acquired, but not if it was aquired in-house? That can't be true..... I am in favor of testing for MRSA at any point available. It can remain dormant for years, but if you do have an active, undiagnosed case, it could infect every patient on the floor. Testing is good for the facility in terms of future liability, good for the other patients, and most importantly, good for the patient being tested. How can we argue the benefits vs the 5 minutes it takes to swab someone's cheek?

[ksilty]

Originally Posted by jlsRN

Many healthy people are positive for MRSA, but not infected. Are we going to have these people in full isolation? Will they all be getting Vanco? What will we be doing with this information other then documenting it?

Many people are carriers of something - HepC or the Sickle Cell Trait. It's a piece of health information that the patient, and providers, should have. Carriers of MRSA should be informed to monitor themselves for potential complications. Carriers certainly should not be treated, that's what created this mess in the first place. I am happy to say that most docs are beginning to follow advice the CDC posted several years ago, and not treating every little bug that comes down the pike with antibiotics. Strepp is a good example - when I worked in ambulatory care, my docs would do a strepp culture on every sore throat that presented (usually at the insistance of the patient), then treat with abx prophy while waiting for the results (Rapid-Strepp is not always reliable). 95% of those tests would come back negative, meaning all those folks took abx needlessly. I'm amazed there are not more super-infections out there.

[Alexk49]

No Medicare patient will be responsible for getting an infection, what CMS is saying the hospital has to eat the cost. Before this change you could up code the DRG payment if the patient acquired a UTI or decubitus. Now hospitals will not get the extra money if the patient has a hospital acquired infection. The patient can not be billed the difference and if they are the hospital could be faced with penalties and fines.


Second the only documentation CMS counts is MD, PA, or NP documentation.RNs and LPNs can chart a million times and it doesn't count.

The fiscal changes take effect October 2008, right now the new codes apply but you can charge the old rates. If you want any more admission, contact your local QIO ( the CMS rep in your area) and they can answer your questions.

How this is going to effect your job? It will effect the organizations bottom line.

[ksilty]

Originally Posted by Alexk49

No Medicare patient will be responsible for getting an infection, what CMS is saying the hospital has to eat the cost. Before this change you could up code the DRG payment if the patient acquired a UTI or decubitus. Now hospitals will not get the extra money if the patient has a hospital acquired infection. The patient can not be billed the difference and if they are the hospital could be faced with penalties and fines.

This sounds like a push for admissions testing. How in the world is CMS going to determine how a patient aquired MRSA during a 3-day stay, or an outpatient procedure? Doesn't sound realistic. We will need a whole new division to CMS - the MRSA Police. I think it would be more realistic to investigate and sanction facilities that can be linked to nosocmical infections. You can believe that nurses notes would be a primary focus of such an investigation. But as far as not paying, this would not be applicable to the majority of facility - aquired infections because of the nature of MRSA.

[ksilty]

Originally Posted by ZippyGBR

carriers of MRSA don't need Vanc - treating an infection that isn't there one of the great failures of US healthcare ( notice no one else in the world using topical antibiotics on none infected wounds and sticking plasters in europe are generally 'unmedicated')

Amen to that...Ours is the only system I know where a doc would dispense antibiotics to treat the common cold just to shut the parent up. We need to develop some backbone with people who "saw it on the internet."