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Hospital-borne ailments face Medicare budget ax

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by INtoFL_RN INtoFL_RN (Member)

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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 paying hospitals for costs incurred from some of the most common and preventable medical errors suffered by patients.

It could be getting a bloodstream infection from a caretaker not thoroughly washing his or her hands. Or it could be developing a dangerous bed sore because a patient's skin was not inspected or cleaned as recommended."

"...Medicare might cease paying for certain conditions acquired by a patient after he or she is admitted to a hospital. Among the proposed conditions to be dropped are:

1. Catheter-associated urinary tract infections.

2. Bed sores.

3. Objects left in after surgery.

4. Air embolism, or bubbles, in bloodstream from injection.

5. Patients given incompatible blood type.

6. Bloodstream staph infection.

7. Ventilator-associated pneumonia.

8. Vascular-catheter-associated infection.

9. Clostridium difficile-associated disease (gastrointestinal infections).

10. Drug-resistant staph infection.

11. Surgical site infections.

12. Wrong surgery.

13. Falls.

Source: Medicare"

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Kim O'Therapy is a BSN, RN and specializes in Onc/Hem, School/Community.

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Wow. It seems to me that the infection examples could be difficult to prove as the hospital's "fault"; however, maybe some institutions will crack down on universal precautions. Either way, once again, the patient will probably suffer. JMHO

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1,343 Posts; 5,651 Profile Views

Perhaps it will be a real wake-up call to hospitals, perhaps it's the patient who will wind up being stuck with a HUGE bill and then they will sue because they can't afford to pay and then the whole US hospital system will just fade to black. Implosion.

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DeLySh specializes in NICU.

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My question is:

How many times have you seen the patients wash their hands after touching their wound, using the restroom, touching thier noses ... etc? If I had a nickel for every time I saw a patient touch their nose (where MRSA loves to colonize) and then scratch or poke at their wound ... and I haven't even started on the floors yet. I understand that Medicare doesn't want to pay for more than they have to but you can't just assume that nosocomial infections come from the facility and its workers and not from the patient themselves (or their visitors.)

DeLySh

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1,711 Posts; 6,838 Profile Views

My question is:

How many times have you seen the patients wash their hands after touching their wound, using the restroom, touching thier noses ... etc? If I had a nickel for every time I saw a patient touch their nose (where MRSA loves to colonize) and then scratch or poke at their wound ... and I haven't even started on the floors yet. I understand that Medicare doesn't want to pay for more than they have to but you can't just assume that nosocomial infections come from the facility and its workers and not from the patient themselves (or their visitors.)

DeLySh

Exactly - some patients contribute to their own complications more than anyone would care to admit - patients who refuse to be turned (bedsores), who refuse to use the incentive spirometer (pneumonia), who keep trying to get out of bed without assistance (falls). Whether medicare wants to acknowledge it or not, there is often times nothing that the hospital staff can do to prevent patients (or their visitors) from causing their own complications.

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162 Posts; 2,071 Profile Views

Wow. It seems to me that the infection examples could be difficult to prove as the hospital's "fault"; however' date=' maybe some institutions will crack down on universal precautions. Either way, once again, the patient will probably suffer. JMHO[/quote']

What will likely come of this is that Medicare will routinely deny payment for most infections, with no real attempt to determine if the patient indeed acquired it from hospital fault or not.

So, hospitals will end up spending many millions wrangling with Medicare. Nurses will end up with yet more paperwork to fill out, and less time in which to do it.

Patient safety will improve a little at best, while lawyers and bureaucrats, the natural constituency of government programs, will do quite well.

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979 Posts; 8,155 Profile Views

Yeah well then they're gonna have to pay thru the nose for a whole lot of things to prevent everything on the list. I mean, falls. Can you imagine the sitter bill alone?

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23 Posts; 1,408 Profile Views

Medicare Won't Pay for Hospital Mistakes

http://www.guardian.co.uk/uslatest/story/0,,-6860189,00.html

Saturday August 18, 2007 9:16 PM

WASHINGTON (AP) - Medicare will stop paying the costs of treating infections, falls, objects left in surgical patients and other things that happen in hospitals that could have been prevented.

The rule change announced this month is among several initiatives that the administration says are intended to improve the accuracy of Medicare's payment for hospital patients who receive acute care and to encourage hospitals to improve the quality of their services.

``Medicare payments for inpatient services will be more accurate and better reflect the severity of the patient's condition,'' Herb Kuhn, the acting deputy commissioner of the federal Centers for Medicare and Medicaid Services, said in a statement.

The rule identifies eight conditions - including three serious types of preventable incidents sometimes called ``never events'' - that Medicare no longer will pay for.

Those conditions are: objects left in a patient during surgery; blood incompatibility; air embolism; falls; mediastinitis, which is an infection after heart surgery; urinary tract infections from using catheters; pressure ulcers, or bed sores; and vascular infections from using catheters.

The Centers for Medicare and Medicaid Services said it also would work to add three more conditions to the list next year.

``Our efforts in this arena and in other payment rules are to ensure that CMS is an active puchaser, not passive payer, of health care,'' Jeff Nelligan, a spokesman for the agency, said Saturday. He said the rule ``underscores our drive toward quality, efficiency and integrity in the hospital setting.''

Hospitals in the future will be expected to pick up the cost of additional treatment required by a preventable condition acquired in the hospital.

``The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication,'' the final rules say.

Congress in 2006 gave the Centers for Medicare and Medicaid Services the power to prevent Medicare from giving hospitals higher payment for the extra costs of treating a patient when infections and other preventable conditions occur during a hospital stay.

Hospitals are to begin reporting secondary diagnoses present on the admission of patients starting with discharges on October 1. Then, starting exactly one year later, cases with these conditions would not be paid at the higher rate unless they were present on admission, the agency said. Last year, Mark McClellan, then director of the Medicare and Medicare programs, said the government could save hundreds of millions of dollars a year if the Medicare program stopped paying for medical errors such as operations on the wrong body part or mismatched blood transfusions. Medicare provides coverage for about 43 million elderly and disabled people. The Medicare program's expenses totaled about $408 billion in 2006; costs are expected to rise rapidly in coming years.

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NRSKarenRN is a BSN, RN and specializes in Vents, Telemetry, Home Care, Home infusion.

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new medicare regulations adopted to reduce certain hospital infections and medical errors

pr newswire

posted: 2007-08-08 10:48:40

washington, aug. 8 /prnewswire-usnewswire/ -- under new medicare regulations, hospitals will no longer receive higher payments for the additional costs associated with treating patients for certain hospital- acquired infections and medical errors. the new rules will give hospitals a powerful new incentive to improve patient care, according to consumers union, the nonprofit publisher of consumer reports.

"every year, millions of americans suffer needlessly from preventable hospital infections and medical errors," said lisa mcgiffert, director of consumers union's stop hospital infections' campaign. "these new rules are a good beginning for medicare to use its clout to mobilize hospitals to improve care and keep patients safe."

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Tweety is a BSN, RN and specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

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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.

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Miss Chybil RN is a BSN, RN and specializes in Med-Surg.

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eileen o'neill-pardo of everett, wash., said her experience showed the need for the rules. her 82-year-old mother, margaret m. o'neill, died of an infection that developed during intestinal surgery at a seattle hospital in 2004.

"the operation-to remove scar tissue-was successful, but the patient died," ms. o'neill-pardo said. "the hospital staff did not take steps to control the infection, which took over her body. my mother died less than a week after the operation."

michigan hospitals have been extremely successful in reducing bloodstream infections related to such catheters, researchers reported recently in the [color=#004276]new england journal of medicine. the hospitals did not use expensive new technology, but systematically followed well-established infection-control practices, like covering doctors and patients from head to toe with sterile gowns and sheets while the catheters were inserted.

hospital executives said these techniques had saved 1,700 lives and $246 million by reducing infection rates in intensive care units since 2004.

some of the complications for which medicare will not pay, under the new policy, are caused by common strains of staphylococcus bacteria. other life-threatening staphylococcal infections may be added to the list in the future, medicare officials said.

http://www.nytimes.com/2007/08/19/washington/19hospital.html?pagewanted=2&ei=5087%0a&em&en=677d68a315d87e50&ex=1187668800

i believe this will benefit patients and that's the real bottom line.

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963 Posts; 25,099 Profile Views

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

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