Did you hear this about Medicaid?

[BittyBabyGrower, MSN, RN]

They will not be paying for nosocomial infection treatments.....man, won't that just be a shot in the ole budget. We were in a meeting for our practice group and this came up from one of the neonatologists. Yes, we all need to be vigilant in preventing nosocomial infections, but I think that this is a bit drastic!

What do you think?

I believe some of the articles came from www.ihi.org We have adopted their care bundles for infection and VAP.

[Elvish, BSN, DNP, RN, NP]

I think it is a slippery slope from there, and I really hope it doesn't happen. Some things may be hard to prove that they would NOT have happened had the pt been at home.

[prmenrs, RN]

Since nosocomial infections (and other iatrogenic complications) often stem from poor staffing practices, seems to me THAT should be the focus of Medicaid's attention.

Not that they're interested in my lousy !! :angryfire

[RainDreamer, BSN, RN]

Wow. I agree that a lot of things would be hard to prove, especially since our entire patient population is immunocompromised to start with.

[EricJRN, MSN, RN]

It's weird that this would be coming out at the same time as we're learning that infections like MRSA are often community-acquired rather than hospital-acquired now.

[catlover314]

I knew Medicare was doing this, but hadn't heard Medicaids were following suit already. Agree with other posters...the smallest and most immunocompromised can't really avoid some infections. I'd be curious to know how Medicaid will sort out those charges, since payment in NICU's is not (or has NOT been) DRG driven. How will they pick and choose which charges to pay? The state I was most familiar with just paid the hospital .57 on the dollar, for example. There was no splitting of charges according to diagnosis.

[justme1972]

Since nosocomial infections (and other iatrogenic complications) often stem from poor staffing practices, seems to me THAT should be the focus of Medicaid's attention.

Not that they're interested in my lousy !! :angryfire

Exactly. They actually covered this very topic in my class just this past week.

At first, we were all shocked, and then our instructor said, "Think about the reasons behind it? How on top of your patient are you going to have to be to practice preventive measures?"

Then she went on to say how that will force healthcare facilities to maintain proper staffing.

[Jolie, BSN]

Then she went on to say how that will force healthcare facilities to maintain proper staffing.

How I wish that were true! And perhaps it will be, but experience has taught many of us that administrators do a very poor job of implementing common-sense measures that would save money in the long run (such as adequate staffing, paying for continuing education, providing appropriate consultants for infection control, etc.) They rely instead on heavy-handed "blame the nurse" tactics and ridiculously expensive outside quality control consultants like Press Gainey.

I worked in one NICU where cutbacks in housekeeping meant that nurses who were providing direct patient care had to empty the trash and take it down to the incinerator. I'd love to compare the infection control rates there to a unit with the proper support staff.

[prmenrs, RN]

:yeahthat:

[aimeern33]

They are no longer going to pay for many things other than CR-BSI's. The fear is that private insurance companies will follow suit and do the same. I am trying to introduce a new IV catheter tip that Vanderbuilt and Duke are starting to use hospital wide that actually cuts down on infection by it's design. It is called the InVision Plus. Look it up and see it if could help you. It probably costs more, but if it reduces what the hospital loses it should be worth it.

[littlepeach]

GA medicaid is a disaster. It has split into three subgroups and they all pay differently. One doctor will accept one, whereas another will not. I work at a level II and when we transport a baby out, we don't get reimbursed for aything. The family gets billed because m'caid will only pay for a single provider. Ga caid has been cracking down on nosocomial infections for some time now. All i have control over is my nursing practices for asepsis. Lab, X-ray, Rt, etc...the list is endless for people that don't wash their hands.

[BittyBabyGrower, MSN, RN]

We are now swabbing all new admissions for MRSA....if we can prove it is coming over with the kids, then they have to reimburse. We have had several kids come back positive from birth.

We have recently implemented several bundles from IHI.org, but our bacteremia rates cont to be high. We are now doing random audits on people to see what they are and aren't doing, and this is for everyone that comes into the unit, from the docs to housekeeping. We are on everyone about handwashing, we have gone totally sterile for line changes, etc. It is so darn frustrating! Our unit is more than adequetely staffed, so that isn't it, but there is something somewhere that is breaking the clean cycle and we just have to find it.