[NP-Clinical] Medicare to Stop Pay for Hospital Errors

Sun Aug 19 17:48:44 PDT 2007

Maybe I'm biased from working in the hospital system, but I've worked at two
very good hospitals that make concerted efforts to prevent infection and
complications. And still they happen, despite our best efforts. I find it
appalling that Medicare appears to be taking a "black-and-white" stance on
these issues.

First, some of these nosocomial infections may start in the field or even
prior to the pt's admission. The hospital can't control what EMS does in the
field. And foley catheters don't sit in a sterile environment; even with the
best technique for insertion and cleaning/care, people will get UTIs.
Despite using the best aseptic technique possible for IV or central line
insertion, dressings become loose or soiled no matter how hard you try to
keep the site clean, dry and free of contamination. It's unfortunate that
pts pull off dressings, sweat, vomit, urinate on or otherwise soil
dressings. Even when turning pts frequently to help prevent decubiti, pts
come in sometimes malnourished or debilitated, or become restless or
outright remove pillows after turning despite the best effort made to
position and make the pt comfortable. Sometimes you can't turn a pt because
he/she is too unstable to do so and a special mattress/bed is not always the
answer. If a pt comes in with an abscess, is Medicare going to blame the
hospital for a MRSA infection once cx grow out, though the pt wasn't dx'd
with MRSA prior to admission?

I agree that all hospitals should and probably can do better. But to blame
the hospital for every complication and deny payment to care for all of
these complications is kind of crazy. Is the hospital going to start
challenging Medicare for payment when a pt in some way contributed to a
hospital acquired infection or decubitus ulcer or the pt had prehospital
care--or lack thereof--that might have contributed to infection or
complication?

The only situation under which to deny payment 100% that made sense to me is
when a hospital leaves a foreign body in a surgical wound. Otherwise, there
is a lot of gray area. A better approach might be to say that Medicare will
deny payment when a hospital exceeds a certain national benchmark for a
given complication.

My humble 2 cents....

Diane Dito

-----Original Message-----
From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Shelby Havens
Sent: Sunday, August 19, 2007 5:16 PM
To: np-clinical at nurse.net
Subject: RE: [NP-Clinical] Medicare to Stop Pay for Hospital Errors

I fear that the costs of treating iatragenic and nosocomial illnesses will 
simply be passed on to the patients. I don't think hospitals will be willing

to foot the bill to pay for these problems or work towards preventing them.

I got a C. Diff infection in a hospital about five years ago. Flagyl was 
prescribed, but I couldn't tolerate it. The RX was changed to oral 
Vancomycin, which I was advised to continue taking for a week after 
discharge. The pharmacist nearly fainted when I got the RX filled. It was 
about $850 for a one week supply. Fortunately, my copay was only $20.

I think a lot of people will die or simply go untreated for hospitals' 
mistakes if insurance companies don't pay for the care needed to treat these

problems. It makes me sad.

Best Regards,

Shelby Havens, ARNP

From: GRETAOB at aol.com
Reply-To: NP Clinical <np-clinical at nurse.net>
To: Acc-circle at listserv.com, NPinfo at nurse.net, NP-Clinical at nurse.net
Subject: [NP-Clinical] Medicare to Stop Pay for Hospital Errors
Date: Sun, 19 Aug 2007 11:21:17 EDT

http://news.aol.com/story/_a/medicare-to-stop-pay-for-hospital-errors/200708
19074009990001

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