Medicare Against Mistakes

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Specializes in Too many to list.

http://www.boston.com/news/globe/editorial_opinion/editorials/

articles/2007/08/22/medicare_against_mistakes/

(hat tip PFI/crfullmoon)

[quote name=//www.boston.com/news/globe/editorial_opinion/editorials/

articles/2007/08/22/medicare_against_mistakes/]

THE FEDERAL government is using the enormous financial power of

Medicare to penalize hospitals where patients are harmed by medical

mistakes. The new policy may require refinement, but it puts US

hospitals on notice that they have got to work harder to make sure

patients do not suffer needless harm while under their care.

Few hospital administrators would object to picking up the cost for such unforgivable mistakes

as leaving a sponge inside a patient or transfusing a patient with the

wrong type of blood. But the

new rule lists six other conditions, the most controversial among

them being hospital-acquired infections.

...hospitals have traditionally been reluctant to release data on infection

rates, let alone lay out a strategy to deal with the problem. Facing the

loss of Medicare money should force them to act.

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The question is is it really an HAI.

We had a guy sign out a few weeks ago AMA. Crackhead, alkie. Nice guy, real PITA. Bed alarm on, wouldn't stay put. BAD fractured albow, fixed up with metal.

Falls on it at home, stoned. He's baa-ack. Arm's infected clear to the wazoo, let alone the bone. NPO ystdy for debriding surgery. Caught chugging water from the bathroom sink.

Do we get paid for him? Because goodness knows he's got no private insurance.

Lovely LOL I was feeding last week because she was, and is, too weak to feed herself. Almost 90. Obese. Of course, because she was "stable," although still terribly debiliated, she's sent home. She's ba-ack. Pneumonia.

Did we do that?

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The way I understand it, there will be ramifications if they do not comply with notification of all infections during a hospital stay. Also, it is only fair that the insurance pick up the tab for something caused in the hospital while the patient is under their care. Why should a insurance company have to pay the enormous charges they bill for treatment, then of course it will be passed down and spread out to all those trying to pay the premiums today.Changes are coming across the board, its going to be felt.

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Specializes in icu, er, transplant, case management, ps.
The way I understand it, there will be ramifications if they do not comply with notification of all infections during a hospital stay. Also, it is only fair that the insurance pick up the tab for something caused in the hospital while the patient is under their care. Why should a insurance company have to pay the enormous charges they bill for treatment, then of course it will be passed down and spread out to all those trying to pay the premiums today.Changes are coming across the board, its going to be felt.

A year ago, this past July, I spent twenty-one days in an ICU because of sepsis, acute renal failure, acute gastritis and pneumonia. My bill came to over $220,000. I only have Medicare. They paid a grand total of $15.000 because all three of the hospitals in my county are classified as rural by the feds. I apparently got the infection in a spider bite that I had had I & D in late May. I was sent to a local LTC rehab unit for wound management where it is believed I got the infection. Not only did the hospital have to eat $205,000 but the LTC facility had the nerve to bill me for $8,000 that wasn't covered by Medicare. I would love to hold the LTC facility responsible not only for the $8,000 but the $205,000 the hospital had to eat.

I know this will bring things down on my head but I have seen nurses enter my room, not wash their hands, handle my IV site, handle dressings and then leave, again not washing their hands. I have put my foot down and told them to wash their hands before they come near me. I am not going to get an MRSA infection or any infection just because someone doesn't bother to wash their hands.

Woody:balloons:

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The real issue here to me is that this is simply a mechanism for Medicare (Federal payer) to control costs. I see this as very much like what they have done with rehab and the CMS-13 diagnosis list and the 75% rule which is in essence all about limiting the federal expenditures to independent rehabilitation facilities. This became a necessity due to demographics; the acute side of the equation is also being tightened.

If a train-wreck comes through the ER without the already present UTI being diagnosed, in no rational world would this be considered hospital acquired. Unfortunately from my experience many infections listed as hospital acquired are simply not known at the time of presentation to the acute care setting.

Another point of concern is patient falls. Human beings do fall down. With due diligence and determined effort, falls can be dramatically reduced but not totally eliminated. The tremendous negative financial impact of making the institution responsible for care costs related to patient falls, which may have no direct linkage to the diligence of the facility or staff, is simply frightening.

The first "boomer" just submitted for social security; in 3 years the floodgates for Medicare enrollment open. We as a nation are in for some very difficult decisions as to how we will ration our health care resources. Yet ration we will be it by wallet biopsy, a nationalization of the health care system or simply having a crisis of unavailability. Reminds one of the old curse "May you live in interesting times"...

Larry

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Won't hospitals be doing blood work and UA's the first thing, then, when someone is admitted? I'm sure they already do don't they?

Won't these tests reveal if patients have an infection upon admission?

These new policies may filter on down to nursing homes, too.

The one where I work part time had several people with foleys who had MRSA.

Sounds like someone was not using good handwashing or wearing gloves.

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Specializes in home health, peds, case management.
the real issue here to me is that this is simply a mechanism for medicare (federal payer) to control costs. i see this as very much like what they have done with rehab and the cms-13 diagnosis list and the 75% rule which is in essence all about limiting the federal expenditures to independent rehabilitation facilities. this became a necessity due to demographics; the acute side of the equation is also being tightened.

*snip*

the first "boomer" just submitted for social security; in 3 years the floodgates for medicare enrollment open. we as a nation are in for some very difficult decisions as to how we will ration our health care resources. yet ration we will be it by wallet biopsy, a nationalization of the health care system or simply having a crisis of unavailability. reminds one of the old curse "may you live in interesting times"...

larry

well said larry...couldnt have said it better myself...changes are indeed in store...

i'm not sure if this is the best solution, but it is a very effective illustration of the fact that universal health care does not, nor should not, equal unlimited coverage.

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Nosocomial wounds and ventilator acquired pneumonia will also be included.

Now that will be interesting from a nursing perspective. Short staffing coupled with high acuity will affect these outcomes directly. I can't wait to see the fallout from that.

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