Hospital-borne ailments face Medicare budget ax - page 3

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   leslie :-D
    Quote from Emmanuel Goldstein
    True, but you know who's going to be blamed...
    i have to agree with you.
    it would be interesting, though, to track those pts who develop infections: and track to whose pts they are.
    the segments who display the highest rates of infection, could be traced to the offending md's....don't you think?
    i can't tell you how many doctors i've seen, who just don't wash their hands or wear gloves.
    i don't understand it.
    what are they thinking?
    or not.

    leslie
  2. by   lvnsandiego
    Steelcityrn's comment about homecare was thought provoking. I have worked homecare for years and many of our skilled nursing visits were for IV ABTS for post op infections or infected surgical wounds. It will be very interesting to see what happens as a result of this new MCR reg. I can see the good and the bad in it. Medicare shouldn't have to pay for things such as left in surgical sponges, etc. The really tricky part is going to be to prove that the health care provider wasn't responsible for things when they truly are not their fault. I have seen countless instances when a pt brings infection or decubitus ulcers due to their own actions, I have also seen them caused by poor care from a health care provider. The article I read said other private insurances are considering following MCR's actions. This is going to get ugly!!!
  3. by   Miss Chybil RN
    Quote from emmanuel goldstein
    you didn't answer the questions...
    what questions? the question about how to stop the infections? i'm not a nurse, or a doctor. i don't know, but these guys seem to have some pretty good ideas, as i posted earlier:

    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.
    or, the answer to your worry patients would be billed?

    the rules, first reported in the star-ledger of newark, carry out a directive from congress included in a 2006 law. when they were proposed in may, consumer advocates said they feared that some hospitals might charge patients for costs that medicare refused to pay.
    but that is forbidden. "the hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication," the final rules say.
    you can find the entire article here:

    http://www.nytimes.com/2007/08/19/wa...&ex=1187668800

    as for the strawman argument... i've never been very good at that. i was simply trying to point out that people are generally resistant to change, but change isn't always a bad thing.
  4. by   EmmaG
    Quote from Miss_Chybil
    What questions? The question about how to stop the infections? I'm not a nurse, or a doctor. I don't know, but these guys seem to have some pretty good ideas, as I posted earlier:



    Or, the answer to your worry patients would be billed?



    You can find the entire article here:


    As for the strawman argument... I've never been very good at that. I was simply trying to point out that people are generally resistant to change, but change isn't always a bad thing.
    These questions:

    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?


    As far as the hospital billing the patient, I understand that wouldn't be allowed; my question is who is going to pay for out-of-hospital treatment for an infection that is on Medicare's 'do not pay' list? Antibiotics are damned expensive; will the patient be stuck with that bill? Or will hospital's now be required to keep patients until all infection is cleared? If so, who pays the costs of extended hospital stays? Extended hospital stays increase the risk of infection, so will they be forced to provide free home care and antibiotics? And take notice that c diff is also on the 'do not pay' list. A condition that can occur as a result of antibiotic treatment.

    So again, how do you propose to prevent infection, especially in a population of patients with high risk factors? Does this mean patients are going to be receiving prophylactic and unnecessary antibiotics? If so, who then is responsible for paying for any opportunistic infections secondary to the antibiotic use (thrush, c diff, etc)? Any idea what impact such a practice will have on establishing even more drug resistant organisms?

    Just wonderin'...
    Last edit by EmmaG on Aug 20, '07
  5. by   Lit4745
    Ok,now let me get this straight. Confuse patient with Alzheimers from the nursing home comes into the ER with nausea and vomiting. Workup reveals acute MI. They go to ICU, (where I work for 25 years). Peeing all over themselves. So, the nurse decides to place a foley cath. Then they pooped, get it all over their hands and play with the catherter. Ok now so you have to clean it up. By the way, she weighs 350 pounds and there is no CNA on duty that day. You finallly get some help, clean her up and fill out your restraint sheet.
    Two days later, she spikes a temp. Urine cultures return positive. Ok, so now the hospital eats the entire hospital bill.
    Ok, guys lets extrapolate a little further. Now your nurse manager calls a staff meeting. Basically, the bottom line is, noone needs a foley catherter-- don't put one in unless absolutely necessary.
    Ok, so for the rest of your 12 hour shift, the patient pees on herself. In ICU, every time you go in for your 2 hour assessment, you are basically doing a complete bedbath and linen change, again without any help. Meanwhile, in your other patients room, the alarm is going off, their blood pressure is low, and your need to call the doc to get an order for dopamine.
    When will these people get a grip. I guess when more nurses get fed up and quit, and there is noone left to take care of the folks, they will finally get it. Because, we all know the hospital isn't going to hire more lifting help, CNA's or unlicensed personnel to clean up the poop, pee, and vomit. Their pat comment is always (and keep in mind I have been around for 25 years and worked in several hospitals). It is always the same. "You guys worked, together, find a buddy, you should have asked for help". Yeah, right when all of the other nurses in the unit have 2 patients on the vent, one getting blood, both on vasopressors, family coming in and of course you have to talk to them and make them happpy, explain everything to multiple family members, etc. Oh, and by the way while all of this is going on, the doc comes up and writes an order for your other patient to go to CT. Let's see, what happens to the patient without a catherter while you are gone? Well, she lays in pee, because everyone else is busy, just trying to keep their patient alive. So, she begins to get skin breakdown. Oh, that's right another diagnosis they won't pay for.
    I love nursing, and don't mind cleaning poop, pee, etc. In fact, I love to see my patients right after their bath and linen change-- usually do it as soon as possible after coming on shift. But, some of the things that are going on -- If I had it do over again, I don't think I would go to nursing school. It is always SOOOO easy to blame the nurse for everything. How many other occupations, do people work their butts off every shift, often without a break or lunch. But let one thing go wrong and you get blamed for it. So frustrating. thanks
  6. by   ElvishDNP
    This is a really stupid idea. Not the part about staff (NOT JUST NURSES) needing to be vigilant about handwashing & other infection control things, that's a duh! sort of thing.

    But it is a slippery slope making the blanket statement that "hospital-borne" ailments won't be paid for. Ok, so I've verified my pt's unit of blood, but what if she develops a reaction anyway? Will they cover that? Will they cover the Benadryl she's going to get? If she has a postpartum hemorrhage, what about that? What if she is in labor, does not progress, and winds up with a c/section? That is technically "hospital borne". (I know some of these may apply to Medicaid as opposed to Medicare, but where one goes, the other is not far behind.)

    I understand the want/need to reduce hospital errors. I really do. But this is taking it too far.
  7. by   EmmaG
    This is so obviously concocted by professional politicians and bureaucrats without a clue.

    Instead of approaching these issues from a risk-management perspective and trying to determine where the breakdown occurs, and develop ways to prevent them from occurring in the first place, the answer is simply to refuse reimbursement. That will make it all go away. Hear no evil, see no evil. Yeah. That's the ticket.


    This isn't going to solve any of those problems. It will simply harm those it proposes to "help".
  8. by   Miss Chybil RN
    Quote from Emmanuel Goldstein
    These questions:

    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?


    As far as the hospital billing the patient, I understand that wouldn't be allowed; my question is who is going to pay for out-of-hospital treatment for an infection that is on Medicare's 'do not pay' list? Antibiotics are damned expensive; will the patient be stuck with that bill? Or will hospital's now be required to keep patients until all infection is cleared? If so, who pays the costs of extended hospital stays? Extended hospital stays increase the risk of infection, so will they be forced to provide free home care and antibiotics? And take notice that c diff is also on the 'do not pay' list. A condition that can occur as a result of antibiotic treatment.

    So again, how do you propose to prevent infection, especially in a population of patients with high risk factors? Does this mean patients are going to be receiving prophylactic and unnecessary antibiotics? If so, who then is responsible for paying for any opportunistic infections secondary to the antibiotic use (thrush, c diff, etc)? Any idea what impact such a practice will have on establishing even more drug resistant organisms?

    Just wonderin'...
    I am not in a position to answer most of your questions. One, I am not qualified and two, I'm not clairvoyant. I can offer one idea as to what will happen to patients who have contracted a hospital induced illness for which Medicare has refused to pay. Unless it is also forbidden in the rules, I wouldn't be surprised to see patients transfered to another facility that will be paid to treat the illness the first facility has been accused of causing.

    If a patient were being treated by their PCP after release from a hospital, unless the PCP was accused, personally, of causing an infection, or committing a medical error, while the person was in the hospital I see no reason the PCP would not be paid for treating the patient. If the patient required prescription drugs for such an ailment, after release from the hospital, I cannot see how Walgreens could be blamed for the ailment and therefore not be paid.

    It is my understanding, if a facility makes an error, or is found to have not prevented a preventable infection, THAT facility will not be compensated for correcting their own errors. Whether any of the other concerns you have materialize, remains to be seen. Surely there will be errors, overcompensations and abuses, but I believe - I hope - in the end, the patient will benefit from a more vigorous attitude towards infection control. We shall see...
  9. by   EmmaG
    Quote from Miss_Chybil
    Unless it is also forbidden in the rules, I wouldn't be surprised to see patients transfered to another facility that will be paid to treat the illness the first facility has been accused of causing.
    How would that work? I don't see doctors and hospitals willing to take these patients in transfer for the purpose of treating an alleged hospital-acquired infection. Why would a receiving hospital intentionally take on that risk?



    If a patient were being treated by their PCP after release from a hospital, unless the PCP was accused, personally, of causing an infection, or committing a medical error, while the person was in the hospital I see no reason the PCP would not be paid for treating the patient. If the patient required prescription drugs for such an ailment, after release from the hospital, I cannot see how Walgreens could be blamed for the ailment and therefore not be paid.
    And again, I want to know who is going to be responsible for payment for outpatient treatment of these conditions and infections that Medicare deems hospital-acquired? (interesting to note that in their 2000+ page report, they acknowledged they won't pay for antibiotic-coated catheters shown to reduce the occurrence of infections, and that the general consensus among ID specialists that UTIs cannot be prevented in patients who have caths in place beyond 48-72 hours... yet they won't pay for treating the resulting infection)

    Another thought... you think we're a lawsuit-happy society now??? Just wait 'til Nana has to pay out of pocket for treatment for c-diff brought on by prophylactic antibiotics to prevent a UTI due to the foley she had to have beyond the 48-72 hours these idiots seem to think should be the limit. And guess who are going to be the ones blamed for these "preventable" occurrences? Better make sure your liability coverage is current and active.

    The personal injury lawyers are going to have a field day with this...
  10. by   vivicaq
    http://www.nytimes.com/2007/08/19/wa...al.html?ref=us
    This is a big one especially where falls are concerned. Whats you take on this?
  11. by   njbikernurse
    I think it's misguided. Yes, some things can be prevented, absolutely. But there's some patients who are going to fall no matter how much you care plan them for fall prevention. It's not a perfect world. It's not like I don't care whether my patient falls until somebody makes me pay for it out of my pocket. So then what, nobody wants to take these patients with a fall history (I'm picturing LTC here) because they won't get paid, and they end up where?
  12. by   cardiacRN2006
    There's a good thread on this already...

    https://allnurses.com/forums/f195/ho...ax-225853.html
  13. by   vivicaq
    Maybe this will tackle the staffing issue. I have worked in long term care and in acute care. The notion that you need less staff (CNAs and PCTs) on nights is faulty. Night shift is when sun downers kicks in, patient have to go to the bathroom too. Hospitals and LTCs need to beef up their roundings. Bottom line over the years our staffing ratios have gone down but the patient acuity has steadily risen. This policy is long over due

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