[RN1980]

well the only way i see this thing change is if the hospital assn puts enough money into congressional/senatorial pockets, to help change some opinions.

[Kelly_the_Great]

Still, I'm not sure that's the change I want either though. Like I said, there are inherent risk in everything we do.

I think reporting for public display (transparency) is the best way to go. Then let the market (patient choice) drive the standard.

This is what happens when you give the govt. too much power. What'll happen, instead of letting the free market push change, it'll limit choice (ultimately with no change) and shut the doors of rural hospitals. The big hospitals will be able to survive but the care will be crappy because they'll have to make cut backs.

[RN1980]

you can already see a trend here with clinics not seeing new patients that are covered by medicare/caid.

[bollweevil]

Originally Posted by TiredMD

There's a saying among surgeons: if you're not having complications, you're not operating enough. That's a terrible saying! An intern was afraid to make the first incision for a GB. The attending told him, "Go on, Son, I can fix any mistake you can make." I know they have to learn somehow but WOW! If the public only knew.

Complications are a reality of medical practice. Bad things sometimes happen despite our best efforts. That's why complications are not, in and of themselves, grounds for malpractice suits. That's why we warn patients of potential complications during informed consent.

Pretending like an iatrogenic pneumo or line sepsis should never happen is ridiculous.

This is just a bunch more reasons I won't be accepting Medicare/Medicaid patients once I'm in private practice.

I agree with the rest of your message. As for not accepting MM pts, I hope you can afford not to. I guess it depends on what type of surgeon you plan to be. Maybe plastics, cosmetic procedures, totally elective private pay. Good luck.

[bollweevil]

Originally Posted by Kelly_the_Great

Still, I'm not sure that's the change I want either though. Like I said, there are inherent risk in everything we do.

I think reporting for public display (transparency) is the best way to go. Then let the market (patient choice) drive the standard.

This is what happens when you give the govt. too much power. What'll happen, instead of letting the free market push change, it'll limit choice (ultimately with no change) and shut the doors of rural hospitals. The big hospitals will be able to survive but the care will be crappy because they'll have to make cut backs.

I agree. Too much gov interference with our lives. Ron Paul for Prez. Back to the Constitution and small gov.

[bollweevil]

Originally Posted by traumaRUs

Yes, we are already seeing side effects from this nonsense. The added expense of testing everyone for VRE and MRSA for one thing. Its only going to get worse, unfortunately.

It doesn't have to. I know it's hard but we have to fight it, publicize it, get people on our bandwagon, have strong PAC lobbyists.

[ocankhe]

I have a different take on this then most of the responses so far. I feel that these new rules are good for health care and good for Nursing. Essentially this paradigm shift on medicare reimbursements and drg payments is good. Historically medicare and medicaid paid for all complications, even preventable ones, so there was no incentive for hospitals (from the bean counters prospective) to deliver the best quality of care. In fact they were rewarded with more income for giving poor quality of care (which they siphoned off for themselves). CMS is now decreasing payments for poor quality of care and putting the focus on preventing as much as possible that which can be prevented. By giving quality of care the hospital increases its income.(or at least prevents a decrease of income). I have already seen increases in budgets for staffing (both RN and ancillary), work design changes, etc. to meet this new incentive system.
Hospitals have a choice, then can spend money on delivering higher quality of care or try and cut costs and staff in face of declining revenue which they in fact caused. Those hospitals that do the former will thrive and be nice places to work in while those that follow the latter courses will eventually go out of business.

[NRSKarenRN]

Originally Posted by TiredMD

This is just a bunch more reasons I won't be accepting Medicare/Medicaid patients once I'm in private practice.

These "NEVER EVENT" standards are being adopted across most major insurance companies sooooo looks like the doctors need to get aboard the nursing quality bandwagon or won't have any income.

Blame it on the nurses....


In 1994, the American Nurses Association (ANA) launched the Safety & Quality Initiative to explore and identify the linkages between nursing care and patient outcomes. This was started largely due to the ancidotal reports/grumblings by bedside nurses of problems of caused by job restructuring and cost cutting (often "slash and burn " style by Hunter group et al) including elimination of unit based head hurse to multi-unit management, laying off of Clinical Nurse Specialists, hospital RN educators, and direct care staff and creating of multitasked unlicensed assitive personal ---who could deliver meal trays, perform ekg's, provide baths and do veinipuctures combining tasks/skills of 4 former positions in name of economy.

•
National Database of Nursing Quality Indicators

The Nursing Care Report Card for Acute Care (ANA, 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings....
..The NDNQI RN Job Satisfaction Survey was developed by KUSON and pilot tested in 2001. Data collection began in 2002. RN Job Satisfaction was the first NDNQI indicator to be collected via the Internet...

Information is collected on the following indicators.

• Nurse Turnover
• Patient falls / Injury falls
• Hospital- & Unit-acquired pressure ulcers
• Physical/sexual assault
• Pain assessment/intervention/reassessment cycle
• Peripheral IV infiltration
• Physical restraints
• Nosocomial infections:
  • Catheter-associated UTI
  • Central line-associated blood stream infection
  • Ventilator-associated pneumonia
• Staff mix :
  • Registered Nurses (RNs)
  • Licensed Practical/Vocational Nurses (LPN/LVNs)
  • Unlicensed assistive personnel (UAP)
• Nursing care hours provided per patient day
• RN education/certification
• RN Survey
  • Practice Environment Scales option
  • Job Staisfaction Scales option
  • Job Satisfaction Scales-Short Form option

Over the last 3-5 years, NDNQI® has submitted nursing-sensitive quality indicator definitions to the National Quality Forum (NQF) in response to requests for indicators. Several NDNQI® indicators have been endorsed through NQF’s consensus measure process (). ANA collaborated with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) via a grant they received from the Robert Wood Johnson Foundation (RWJF) to develop the micro specifications of the NQF nursing measures.

See: Web Presentation

Now you have CMS (Medicare) Physician Quality Reporting Initiative (PQRI)

AMA (CQI) Participation tools: Medicare Physician Quality ...

Many of the measures in the PQRI were developed by the AMA-convened Physician Consortium for Performance Improvement®, in collaboration with the National Committee for Quality Assurance (NCQA) and/or a medical specialty society. For additional information on the Consortium including additional background information on the quality measures with both the rationale and evidence base for each measure, please visit the Physician Consortium for Performance Improvement Web site.

LEAPFROG Group F A C T S H E E T on Never Events.


Insurance companies now on the quality bandwagon:

Aetna to stop paying hospitals for 'never events'.
Aetna Incorporates Patient Safety Language into Hospital Contracts

CIGNA Newsroom: Promoting Patient Safety: CIGNA to Stop ...

BCBS plans phasing out pay for errors, 'never events ...

WellPoint to stop reimbursement for "never" events - Silicon ...

Achieving the National Quality Forum's "Never Events": prevention ...


All in the name of PATIENT SAFETY and improved quality of care.

[TiredMD]

Originally Posted by NRSKarenRN

These "NEVER EVENT" standards are being adopted across most major insurance companies sooooo looks like the doctors need to get aboard the nursing quality bandwagon or won't have any income.

Interesting info, thank you.

Guess I'll just have to not take insurance. Cuts down on overhead, after all.

[interleukin]

Largely, by it's own devices, nursing is slowly imploding.

We've allowed any and all tasks and expectations which are not physician specific to be simply grandfathered into our practice.

Each month,there is new duty which is unceremoniously dumped into our laps.

And now come a plethora of new expectations all of which are based upon some Utopian notion that nursing can be micro-managed into practice perfection.

Nursing has never been able to say, "No" and because of it's cowardice we are all going down and we will be taking the health of our patients with us.