Medicare: "Hospital-Acquired Conditions" and "Present on Admission"

[NRSKarenRN, BSN, RN]

from ana current capitol update volume 6/issue 1january 30, 2008

medicare: "hospital-acquired conditions" and "present on admission"

in december, the centers for medicare and medicaid (cms) held a public discussion seeking input on the new policies regarding "hospital-acquired conditions" and "present on admission." beginning october 2008, hospitals will receive lower medicare reimbursement if their inpatients suffer from "hospital-acquired conditions" which were not documented as "present on admission." the ana supports efforts to improve clinical quality and patient safety by reducing adverse events.

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reporting healthcare associated infections: a state perspective

healthcare-associated infections (hais) are one of the top ten causes of death in the u.s., with estimates near 99,000 deaths each year. these infections are acquired by patients while receiving treatment for other conditions within a healthcare setting. the american hospital association's conducts an annual survey of hospitals and their characteristics. the 2002 survey revealed that of 1.7 million hospitalized patients, there were 155,668 deaths, of which 98,987 were caused by or associated with a hai, resulting in an estimated $4.5 billion in excess healthcare costs annually. prompted by the desire to improve patient outcomes and reduce costs -- along with an increased consumer demand for healthcare information -- a number of states have enacted legislation mandating that hospitals report cases of hais.

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[psalm, RN]

My mother-in-law is in a lather over this, she thought it meant the patient would have to pay the difference if the pt. got the nosocomial infection. I had to explain to her what it meant.

[glasgow3]

Yup....We've started swabbing for MRSA on every admission these days. Just one more chore added to Home Medication Reconciliations, Suicide Scales, Skin Scales, Stroke Scales etc etc etc.....Never seems to slow down, let alone stop.

[classicdame, MSN, EdD]

I see this as a great way to show the value of nursing assessment.

[psalm, RN]

I see this as a great way to show the value of nursing assessment.

I definately agree with you, it's too bad we won't be getting more staff so that we as nurses can PROPERLY assess/document/intervene in a timely manner.

[suanna]

What an idiotic idea! Now we are nasal swabbing every admission for MRSA. UAs with even the slightest indication of a UTI are cultured. Defensive testing is at an all time high. If we devoted the $ and resources we are expending for defensive testing to better equipment, supplies, staffing- maybe we would see a change. Honestly, patients in a hospital are susceptible to infection. They are exposed to bugs that they would never see in thier daily lives. They are old and sick. They are fighting off whatever put them in here to begin with. Guess who is going to end up paying for treating the infection- everyone. The hospital is going to have to pass on the cost of the treatment in room charges, lab fees, other drug costs... Or of course there is always cut staffing, lower wages, eliminate benifits.....

What is the alternative-"sorry for your luck but you picked up MRSA in your sternum post op cabg guy. We could treat it but it's pricey to fix and your insurance dosen't pay for that so you will just have to die."

[FireStarterRN, BSN, RN]

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?

[Katie82, RN]

Yup....We've started swabbing for MRSA on every admission these days. Just one more chore added to Home Medication Reconciliations, Suicide Scales, Skin Scales, Stroke Scales etc etc etc.....Never seems to slow down, let alone stop.

Meds reconcilliations, suicide scales, stroke scales - a lot of this comes under the blanket of preventive medicine and would the patient would be better served if his PCP were doing this. As a medical community, we are encouraging the population to take advantage of managed care, but few PCPs actually manage their patients' care. As a case manager, when I open a new case, I travel to the PCP's office and review that patient's record. I always leave notes on the chart asking them to perform or refer screenings that are already standards of care. Problem is, the docs have little time to do this. THey are pressured to produce a minimum # of RVUs every month, and they can't accomplish these goals if they spend an appropriate amount of time with the patient. I perform all these scales on my patients, but I only manage 100 patients at a time. Don't see any quick solution to this, and it will get worse if CMS achieves its goal to put Medicare in managed care. I think case management should be done in every PCPs office, and funded by insurance. My program saves millions for the State by case managing Medicaid patients. If every medical practice or practice group had a nurse dedicated to case management, there would be much less need to waste the acute care providers' time with prevention scales. Of course, the real goal would be to get everyone into a "medical home" instead of the fragmented care some now receive.

[Katie82, RN]

What an idiotic idea! Now we are nasal swabbing every admission for MRSA.

What is the alternative-"sorry for your luck but you picked up MRSA in your sternum post op cabg guy. We could treat it but it's pricey to fix and your insurance dosen't pay for that so you will just have to die."

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

[Nursebarebari]

I'm sure that means more paper work and less patient care. Hmm, it never get easy.

[rjflyn, ASN, RN]

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]

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.