I’m not sure whether to stand up and applaud — or to begin worrying even more about patients who are hospitalized….
This report just in from Consumers Union, the not-for-profit organization that runs www.stophospitalinfections.org … here is their press release, too….
Beginning in October 2008, Medicare (CMS: Centers for Medicaid and Medicare Services) will no longer pay hospitals for any extra care a patient needs if that patient acquires any of three types of infections while hospitalized (NOT including MRSA), or five other non-infection related mistakes or “accidents”, including bedsores, falls, or objects left inside a person’s body.
The basis for the new law is this: if hospitals know they won’t get reimbursed, then they will be more likely to make sure those things don’t happen. The current statistics tell us that 2 million patients acquire a hospital infection each year, that 100,000 of them die — and other medical mistakes account for up to 100,000 American deaths per year.
ALL preventable.
Knowing that American healthcare is not about health or care, it’s about sickness and money — the new law makes sense. I applaud the efforts of Medicare to address preventable infections and errors!
But — I do see a few problems — no answers — but sometimes asking the questions makes us aware of the problems that might occur….
Why isn’t MRSA (methicillin-resistant Staphylococcus aureus) included as one of the 8 conditions? It’s a superbug that is 99% acquired in hospitals. Patients can be tested before they are admitted, so hospitals will know if a patient has MRSA…. and it will be obvious if it is acquired while a patient is in their care. The press release says it’s because “not everyone believes MRSA can be prevented…” — and I say to that — yes it can! Steps taken in Europe show that hospitals CAN clean up their acts enough to get rid of MRSA.
Just because Medicare will stop paying doesn’t mean those errors won’t happen. So how will hospitals pay for them? They may happen less frequently — but they will still occur! So how will they get paid for?
It seems to me the rule of unintended consequences will kick in big-time here. Some possibilities: the real causes of problems will be covered up (fraud — yes, fraud), the charges will end up on the patient’s bill in some convoluted way (even though the new regulations expressly forbid it.) Hospitals unable to keep up with these new costs will close down, leaving patients who need services in the lurch — an even bigger problem in rural areas where other hospitals are not available….
It’s not that I don’t think Medicare is making a real, bona fide effort at improving safety for patients in hospitals — I do. I’m just not positive that their “smart” decisions won’t end up being even more costly for us all in the long run.
A copy of the new CMS regulations can be found here (begin at page 290):
http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/CMS-1533-FC.pdf
Your thoughts?
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yeah this is great. i love it
I have to disagree with this approach. I think we all know what happens when Medicaid/Medicare refuses to pay… the patients simply won’t get the best treatment, but rather the most cost-effective. The patient didn’t cause the infection or the medical error so it should in no way effect that patient or any other patients who will now be charged more to make up the growing costs for what Medicaid refuses to pay.
My opinion, however, isn’t truly biased. I have some MAJOR issues with how the Medicaid program is ran and my first impression was that Medicaid has come up with a good way to cut down on expenses by picking and choosing what they will or will not pay for and have packaged it up in a way that makes us think they are doing us a favor.
I think the “stophospitalinfections” site is onto something! We SHOULD have an accounting system for all hospitals NATIONWIDE, and not just so that patients could be aware of the offenses, but so that penalties of some sort could be implemented. Fining doctors and other healthcare workers who fail to follow infectious control standards or make mistakes would be more up my alley! But… yeah… like THAT will happen!
I have a couple of comments I would like to make. The first is that not all bedsores are preventable, though I admit the vast majority are. In the pediatric ICU, we sometimes have patients who, either due to trauma or a severe pneumonia, suffer a complete respiratory collapse. The only way to save their life is to put them on a ventilator to breath for them. On some occasions, these patients are so sick that their bodies have literally no energy reserves. It is taking every ounce of energy they can produce just to keep their heart beating. ANY stimulation of these patients (touching, moving, even talking around their bed) can cause a depletion of the energy they have left, causing cardiovascular failure (the heart stops). We need, in these cases, to make the decision that we can treat the bedsores later, when they a recovering from the acute illness, rather than risking their life now. We must make the call that preventing bedsores will not matter if they die as a result of the prevention. I would hope we are not now being forced to make the wrong decision in these cases.
As to the question of MRSA, I agree 100% that we should test everyone who is admitted on admission so those who already have MRSA can be isolated. There have been many occassions where I have worked with a patient for 2-3 days before the it was discovered that they had MRSA. This not only puts my other patients at risk, but also makes me worry about my own family since I have 2 young children at home. So I would propose the argument that testing all patients on admission protects, not only other patients, but the healthcare professionals also. I know they already do this at most hospitals whenever anyone is admitted from a nursing home, but now MRSA is in the community at large. This is known as ‘community aquired MRSA’ or CA-MRSA. Yes, we love our abbreviations and acronyms, don’t we. See the following link for a story on this subject.
http://www.medicalnewstoday.com/articles/72560.php
Lastly, I would like to defend my profession a bit. We do everything we can to prevent these things from happening. I cannot speak to the mistakes such as an object being left in someone after surgery, but I can almost absolutely state that these types of things are never done intentionally. I know nosocomial infections (acquired in the hospital) are almost always blamed on the nursing staff. This is reasonable since we have the most prolonged, closest contact with our patients. However, I would also like to see addressed the working conditions of nurses. What is scarier than anything else is that the hospital decides what is a ‘safe’ staffing level. There is currently a severe shortage of nurses in this country that is only projected to get worse. According to the US Dept of Labor, there are currently 50,000 more nursing positions open in the country than the total of all licensed nurses. This number is projected to increase to 100,000 by 2010. While this doesn’t account for those working more than one job, it also doesn’t factor in those still licensed but no longer practicing. There are some places where a nurse is expected to care for 6, 7 and even 8 patients. Nursing homes have come to the point where they may only have 1 or 2 RN’s working at any one time and the rest of the patient care staff are nurses aid’s making barely more than minimum wage. This, to me, is a recipe for disaster. It sets up the nurses for errors in medication, treatments, etc. Remember, for every patient, there is an inordinate amount of paperwork. We get sued for malpractice too. I think there really needs to be some legislation enacted mandating safe staffing levels for nursing. California did so against the strong lobby of the hospitals. The hospitals made their usual arguments about not being able to find enough nurses, would have to close beds, could not afford the levels, etc. What happened after the law went into effect? California was inundated with all the qualified nurses they could handle due to many relocating to CA because of the law. Now, CA is the best place in the country to practice as an RN. There are many nurses who have changed careers because of this issue, further contributing to the problem. I, personally, would not consider this as I get too much fulfillment from being a part of the ‘miracles’ we make everyday. I’ll get off my soapbox now.
Marty Gister, RN
i am a 48 years old disabled women. i am on medicare. i have been sick for six weeks 1-2-08. rash from scalp to my feet. i have gone to two hospitals two ugent care. three doctors. within a week of my getting this my husband son brotherinlaw got it. i had minor surgery. on nov -12 -2007. by that night i had a large red spot on my lower back with 3 or 4 blisters in it. on nov- 15 – 2007 my husband had surgery in hospital four days. on nov-21-2007. i looked in my mouth and had the worst throat and mouth infection i had ever had. went straight to primary. he claimed it was shingles. within 24hours i had rash from top to bottom within 72 hours my entirer head shed. within one weeek the three others had it. we all tested neg for strep. on dec-14-2007 my husbands doc called and said his came back as mrsa. i have been every place mentioned at the top. none of them would or will test me. they become sooooo angry disrespectful they deny all of my symptons rash all of them. they have told me that they do not test for staph all but one of them said that. i am very sick we all are. throats are not any better swelling joints.very red sore swollen tongues horrible stomach aches. we live in north carolina do you know why all of the anger why all the denial. my husband was sent to an infectious disease doctor on dec-28-2007. he confirmed mrsa. still has not gotten treatment yet. we all need treatment. we have all been on 3 to 5 antibiotics none of us are getting any better. as soon as meds are gone we get sicker. help me understand if you can. there is something seriously wrong with this picture. sixs weeks antibiotics wound help. seems like mrsa to me.
i am a 48 years old disabled women. i am on medicare. i have been sick for six weeks 1-2-08. rash from scalp to my feet. i have gone to two hospitals two ugent care. three doctors. within a week of my getting this my husband son brotherinlaw got it. i had minor surgery. on nov -12 -2007. by that night i had a large red spot on my lower back with 3 or 4 blisters in it. on nov- 15 – 2007 my husband had surgery in hospital four days. on nov-21-2007. i looked in my mouth and had the worst throat and mouth infection i had ever had. went straight to primary. he claimed it was shingles. within 24hours i had rash from top to bottom within 72 hours my entirer head shed. within one weeek the three others had it. we all tested neg for strep. on dec-14-2007 my husbands doc called and said his came back as mrsa. i have been every place mentioned at the top. none of them would or will test me. they become sooooo angry disrespectful they deny all of my symptons rash all of them. they have told me that they do not test for staph all but one of them said that. i am very sick we all are. throats are not any better swelling joints.very red sore swollen tongues horrible stomach aches. we live in north carolina do you know why all of the anger why all the denial. my husband was sent to an infectious disease doctor on dec-28-2007. he confirmed mrsa. still has not gotten treatment yet. we all need treatment. we have all been on 3 to 5 antibiotics none of us are getting any better. as soon as meds are gone we get sicker. help me understand if you can. there is something seriously wrong with this picture. sixs weeks antibiotics did not help. seems like mrsa to me.