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The big news this week is that Medicare is going to stop paying for medical mistakes. That was the headline put out in every paper around the country. Sounds ridiculous, right? Why would the government pay for mistakes (Iraq, FEMA, etc.) in the first place? Well, the answer is not that simple. According to the administration, Medicare will no longer pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.” This includes bedsores, injuries caused by falls, and infections resulting from the prolonged use of catheters in blood vessels or the bladder. They also won’t pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.
Intuitively, this sounds pretty smart. But is it? Obviously, the intention to stop neglect is a good one. There are, however, times when bad things do happen and it is not anyone’s fault. The future fallout from this will be very interesting. This means more administrative oversight to double check everything on each patient in the hospital which means more, well, administrators. That can’t be a good thing.
I am fully aware that we can always do better. But a UTI from a catheter? Trust me, there is going to be a lot of fudging in future documentation. No doc is going to want to be dinged for making these “mistakes”.
Yes, it is wrong to leave a sponge in someone’s peritoneal cavity. A bed sore, however, in a quadriplegic 400 pound man is going to be tough to stop. Did that sore start before they came in? I guarantee that there will be more “diagrams” on the chart highlighting anything close to looking like a sore. Doctors will have to get some extra blood and urine tests before the patient gets admitted just in case something shows up later. This won’t cost too much; now will it?
The bottom line is that while I agree on the intention, I am very suspect of the initiative. There are now going to be infection police roaming the hallways like elementary school hall monitors looking for bathroom passes. There will also be accident teams that will be skilled in the art of documentation manipulation that will allow the hospital to show that they were not at fault. The cost of these new jobs will, in my estimation, equal what it was before they were created. And don’t forget the new MRSA wings that keep these patients in total isolation from everyone else. That has got to cost a pretty penny as well. Oh well, I guess the hospital will just have to raise its rates somewhere else to make up for it. It’s not like they are going to cut their CEO’s salary.
Lastly, hospitals are going to have to report this data on how good they are doing. Ranking systems will be constructed and nice new awards will have to be created so the “cleanest” hospitals will enable their marketing team to brag to the media. Alabash County Hospital winning the Golden Catheter Award is good PR and a great story for the local paper. This is going to be fun and in the long run, a pain in the ass.
11 comments:
Doug, I don't for one sceond agree with the intention of this transparent "initiative." Like pay-for-performance, the purpose of this move will be to allow Medicare to withhold money from hospitals and doctors, rather than admitting this is an unafforadable program badly in need of reform. This is not an intent to stop neglect, but another government lie disguised as quality improvement.
Welcome to the wonderful world of what socialized medicine will be. And folk like Michael Moore (no offense, Dr. Doug) are pushing us closer and closer to the brink.
I foresee all sorts of "unintended consequences" to this. You could stretch it to mean that patient noncompliance is the fault of the hospital and thus sequelae of diabetes, high blood pressure, ad infinitum, are not coverable illnesses.
MRSA happens, no matter how careful the staff is. Your 400-pound quadriplegic with decubiti is a perfect example. The consequence to a rule like this is that it will be even harder for someone in that situation to receive care - who's going to admit a patient who very likely is a catastrophe waiting to happen?
Doug asked, "what is CRS?" It's "can't remember shit." Like Alzheimer's, only funnier.
No kidding! And let's not forget the mediastinitis mistake.
I posted a rather wordy diary on Daily Kos about this. I agere with Dr. Farrago that all catheter infections and bed sores are likely to be treated as if they're just as clearly the doctor or hospital's fault as an instrument left in the patient at surgery.
Here's a link:
http://www.dailykos.com/storyonly/2007/8/18/223215/123
For what it's worth, I think what I wrote explains the reasoning in pretty much detail, in layman-friendly terms.
Question....Will the courts mandate that facilities/caregivers be reimbursed for treatment of these "mistakes" from the settlements of lawsuits filed by patients and/or families who have suffered from these "mistakes"?
The snakes must be slithering with joy at the prospect of Medicare basically handing over neglect and malpractice cases with each and every denial.
I am a RN with 12 years hospital experience, who left hospital work last year. Newsflash: sick people are sick, and they pick up bugs, and they often deteriorate. It is that the medical profession's fault? And I thought HIPPA was bad...All I can say is THANK GOD I am out of that mess. I can just see how this will play out, with already overburdened and harrassed nurses being dogged and scrutinized even more. Nursing staff will once again be (subtly) cut in an effort to save the hospital's bottom line. I am now giving flu shots and contemplating my next career. There needs to be someone pushing back, in both medicine and nursing. Can't the AMA dig up docs in every state to run for public office, every election? We need an audible voice in Washington.
Please...it's too late to think anything can be done. This is just another way of cutting costs, the truth be damned. You just have to sit back and admire the utter cynicism of this maneuver--personally I suspect it was the brain-child of some recent law school grad (who, to make it worse,is very likely idealistic and really and genuinely wants to rein in healthcare costs and improve quality of care).
It isn't about facts, and never was; it's about marketing to the public. Either the medical profession (excuse me, medical-pharmaceutical industrial complex) is in favor of good care (i.e. nary a bedsore) or it's not, in which case they (ooops...we) are a bunch of money-grubbing, uncaring, callous butchers who are perfectly content to have patients rot and die as long as we get paid. In which case, we DESERVE to get stiffed...and that's the way it's packaged. It'll play in Peoria, never fear.
So I can put my demented patient in restraints so she doesn't fall and break a hip, but then she'll get bedsores. No Foley for her, cause she might get a UTI. But her diaper won't get changed in a timely fashion, so it's butt excoriation.
We're all doomed.
The solution is simple: don't admit sick people who are going to ruin the nice and tidy reputation of the hopsital and the admistrators.
The 400 lb man and the nursing home patients may be on their own.
This is only going to worsen care for patients in my opinion. Many patients go to another doctor when the first one "screwed up" (we are only human and bound to do this occassionally). The next doctor will not get paid for making the mistake right so no one will want to see these patients. Hospitals will try to deny admission of tough cases and really sick multiple problem patients in fear a complication may arise and they may have to eat part of the bill. The patients will be transferred out a soon as possible to other hospitals as to not upset EMTALA. So everyone will be paranoid on why a hospital wants to transfer a patient. They will always be asking "are we going to get screwed on this one?". Patients won't get the care they need. Hospitals will pick and choose to make themselves look better. Trust me I have seen surgeons that already do this to keep their numbers looking good. They put a patient that needs a lap chole through a battery of tests to make sure they are truly healthy and then if they don't feel comfortable operating refer on. How is this any different? Will we create hospitals for the "too sick" or "possible complications may arise"? Who will fund the care for these patients? Health care costs will eventually rise higher than they were. Whoever thought up this bright plan has no clue as to how health care works today or was too short sighted to think it really through or truly an idiot. I think the later is more likely.
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