Hospital-borne ailments face Medicare budget ax - page 2

Feds consider ending payment for common medical errors Indystar.com "Medicare says it might no longer pay for many of the mistakes made by hospitals. Late next year Medicare plans to stop... Read More

  1. by   oramar
    Quote from StNeotser
    Some of this I can agree with. However, the hospitals will not put on any extra staff to deal with nosocomial infection and nurses will be berated for any UTI or infection that comes up.

    Then the real cost will be passed on to those of us who are already paying for health insurance because the hospital will have to put it on someone.

    Well done again Bush. :0
    You are correct, not to mention there is going to be additional paper work for nurses and that will mean even less time at the bedside.
  2. by   Miss Chybil RN
    Quote from oramar
    I will give you example about how things can be a lot more complicated than you think. For instance, I had patient who got mediastinitis after bypass surgery. Inexcusable according to these guidelines. However, there were extenuating circumstances. Turns out he was on a experimental prostate cancer drug that supressed his immune system. The infection was a side effect of the drug not due to negligence of hospital staff. There are a lot of ifs, ands and buts in medical care and I think you are making a mistake.
    There was a time when doctors balked at the idea of needing to wash their hands between doing autopsies and delivering babies.

    In the 1840s, puerperal or childbirth fever, a bacterial infection of the female genital tract after childbirth, was taking the lives of up to 30% of women who gave birth in hospitals. Women who gave birth at home remained relatively unaffected. As assistant professor on the maternity ward of the Vienna General Hospital, Semmelweis observed that women examined by student doctors who had not washed their hands after leaving the autopsy room had very high death rates. When a colleague who had received a scalpel cut died of infection, Semmelweis concluded that puerperal fever was septic and contagious. He ordered students to wash their hands with chlorinated lime before examining patients; as a result, the maternal death rate was reduced from 12% to 1% in 2 years. Nevertheless, Semmelweis encountered strong opposition from hospital officials and left Vienna in 1850 for the University of Pest.

    http://www.cdc.gov/ncidod/EID/vol7no2/cover.htm
    Change is difficult but, in my opinion, the increased pressure on the hospital's bottom line will encourage better patient care. This does not mean I believe there won't be abuses of the new rule by the Medicare dept. and by hospitals, but it is a "make sense" rule for me. The kinks will need to be worked out as we go.
  3. by   EmmaG
    Geez.

    Here comes MORE paperwork :angryfire
  4. by   steelcityrn
    I look for smaller hospitals not surviving any further medicare cuts. And, I wonder how this will apply for someone coming home with a hospital aquired problem in homecare. Will they pay the homecare bill? Don't see any homecare companies able to work for free
  5. by   EmmaG
    Quote from Tweety
    Some of them I can support. Others like C-diff, UTIs, VAP, etc. I can't. Sometimes a patients weakened condition, medication side effects, or a confused person pooping and playing with their foleys, can cause problems that have nothing to do with poor hospital care.

    Bad idea.
    Horrible idea. I agree with some, as in incompatible blood, wrong limb surgery, etc.

    So what does this mean? Every patient is going to be pan-cultured and screened for MRSA/VRE upon admission? Who pays for outpatient treatment for an infection Medicare deems was hospital-acquired? These old folks are going to end up being squeezed from both sides--- again.

    Are we going to be putting all patients on prophylactic antibiotics now? Will Medicare pay for antibiotics in the absence of infection? They think the infection rates of drug-resistant strains are high NOW...just wait until we've had a few years of this inane policy.
  6. by   Miss Chybil RN
    Quote from Emmanuel Goldstein
    Horrible idea. I agree with some, as in incompatible blood, wrong limb surgery, etc.

    So what does this mean? Every patient is going to be pan-cultured and screened for MRSA/VRE upon admission? Who pays for outpatient treatment for an infection Medicare deems was hospital-acquired? These old folks are going to end up being squeezed from both sides--- again.

    Are we going to be putting all patients on prophylactic antibiotics now? Will Medicare pay for antibiotics in the absence of infection? They think the infection rates of drug-resistant strains are high NOW...just wait until we've had a few years of this inane policy.
    The new rule does not allow hospitals to bill patients for treatment Medicare has refused to pay because they have deemed the illness the hospital's "fault."
  7. by   CHATSDALE
    a long time ago when i begun nursing all cbag pts were kept a mnimum of 10-12 days...when medicare/hmos decreased the amount of days that would be paid all the pts miraculously became able to leave in the agreed amount of time..probably saved some of the lifes d/t limited exposure to hospital super bugs
    hands need to be washed, orders double-checked against dx, patients turned and famimily members need to be informed of the need for this, close assessments done on a routine basis
    these are things that you do anyway..if this benefits the patient i have no problems with it
    Last edit by CHATSDALE on Aug 19, '07
  8. by   EmmaG
    Quote from Miss_Chybil
    There was a time when doctors balked at the idea of needing to wash their hands between doing autopsies and delivering babies.



    Change is difficult but, in my opinion, the increased pressure on the hospital's bottom line will encourage better patient care. This does not mean I believe there won't be abuses of the new rule by the Medicare dept. and by hospitals, but it is a "make sense" rule for me. The kinks will need to be worked out as we go.
    Your post is a strawman argument to the very real problems brought up by oramar. No one is saying that infection control isn't an issue. What some of us are saying is that hospital-acquired infections are not always the fault of the hospital.

    How do you propose to prevent these infections?
  9. by   EmmaG
    You didn't answer the questions...

    Quote from Miss_Chybil
    The new rule does not allow hospitals to bill patients for treatment Medicare has refused to pay because they have deemed the illness the hospital's "fault."
  10. by   woody62
    My only insurance is Medicare. I was admitted to an area hospital in spetic shock and acute renal failure from the rehab unit of a local nursing home. Three weeks prior, I had had an I & D of a spider bite. The spetic shock was traced back to the wound from the I & D. Who should be responsible for my hospital bill? The LTC facility, the first hospital I was in? The second hospital I was in? Who made the mistakes? The doctor who followed me in the LTC facility? He didn't keep me on an antibiotic when I was first admitted. The surgeon who did the I & D? He didn't discharge me to the LTC facility on an antibiotic. In my case, I believe that the surgeon, the LTC physician, the LTC facility all played a role in my problems.

    I know I didn't pick at my wound, it was too painful undergoing the daily dressing changes. So, I don't believe I played a role in what happen to me. But I have watched staff come in, without washing their hands, to change IV's, to check dressings, to do any number of things that open me to an infection. And when I ask them if they have washed their hands, they either:
    1. Get embarassed and go wash them
    2. Mutter and ignore my question
    3. Get defensive and ask me what my problem is

    In some cases I believe the hospital and staff are responsible because of breakdowns in their oown procedures. And at other times, I think some things just happen.

    Woody
  11. by   leslie :-D
    for yrs, i have been aghast at the quantity of nosocomial infections and deaths, r/t preventable errors made by medical staff.
    reports of aforementioned, have always sounded so casual and dismissive:
    that these things happen, and that's just the way it is.

    w/o understanding the full implications of proposed medicare cuts, overall, i'm glad.
    as long as it doesn't come back to blame nursing.....again.

    my other concern is there are events that are usually unrelated to mishandling of staff.
    as tweety said, a compromised immune system will create many secondary complications.
    this needs to be a major consideration.


    leslie
    Last edit by leslie :-D on Aug 19, '07
  12. by   cardiacRN2006
    And how do we get the drs to wash their hands????
  13. by   EmmaG
    Quote from earle58
    for yrs, i have been aghast at the quantity of nosocomial infections and deaths, r/t preventable errors made by medical staff.
    reports of aforementioned, have always sounded so casual and dismissive:
    that these things happen, and that's just the way it is.

    w/o understanding the full implications of proposed medicare cuts, overall, i'm glad.
    as long as it doesn't come back to blame nursing.....again.

    my other concern is there are events that are usually unrelated to mishandling of staff.
    as tweety said, a compromised immune system will create many secondary complications.
    this needs to be a major consideration.


    leslie
    True, but you know who's going to be blamed...

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