Makes sense on paper, but as always, it’s not always that cut and dry:
But Ms. Foster said that some of the conditions cited by Medicare officials were not entirely preventable. Commenting on the proposed rules in June, the American Hospital Association said, “Certain patients, including those at the end of life, may be exceptionally prone to developing pressure ulcers, despite receiving appropriate care.”In most states, Ms. Foster said, hospital records do not show whether a particular condition developed before or after a patient entered the hospital. Under the new rules, she said, hospitals will have to perform more laboratory tests to determine, for example, if patients have urinary tract infections at the time of admission.
(via MSSPNexus Blog)
Some blogosphere reaction -
Chris Rangel:
“It would make more sense for CMS to establish a maximum number of these types of complications per year per hospital based on the number of these cases one would expect to see using the best preventative measures. Then they can penalize hospitals that exceed the maximum.
Otherwise it’s not improbable that some hospitals and physicians may take steps to avoid having to treat patients who are at high risk for these complications. Never under estimate the law of unintended consequences (or the ability of hospitals like any business to try and save money).”
Zagreus Ammon:
“There is no rule that intelligent people can’t find a way around. For every rule, there is necessarily a countermeasure. The NY Times article included commentary that suggests documentation of the presence or absence of infections at admission will become a priority. If you can prove someone was admitted with an infection, you’ll get paid for the admission. This means that all patients will probably get blood and urine cultures on admission. A misguided rule can bankrupt the country in microbiology tests alone.”
Shadowfax:
“It’s the next logical step in pay-for performance. The goal is laudable and the effect will probably be beneficial, but it is a little frustrating to view from this side of the fence. Medicare insiders will tell you quite frankly that while they (as we) view patient safely/quality of care as the highest priority and ultimate goal, these measures are being instituted with the underlying intent of cost containment.”
Medpundit:
“It’s probably reasonable to expect a hospital and surgeon to remove a left behind sponge at now added charge, but some of these conditions are difficult to avoid. Patients who require chronic urinary catheters, for instance, are notoriously prone to infection despite the best efforts to avoid them. And dying, chronically ill patients are prone to bed sores despite the best efforts to prevent them.”
Dr. A:
“When it comes to preventing infection, I see more unnecessary testing being done to prove that an infection was obtained before hospitalization. What will be the cost of this? In addition, I see even more increased use of antibiotics, which will further increase the resistance of organisms – and complicating the treatment of infections in the future.”
