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.”
{ 4 comments… read them below or add one }
Thanks for the link!
Anyone with a hint of medical knowledge knows that UTIs in cath patients are fact of life - especially in the elderly and diabetics. Perhaps it would be better to not put a cath in and let them get hydronephrosis and overflow incontinence. The ensuing renal failure and dialysis will presumptively be paid for, I guess.
Unfortuntely, the hospitals taking care of the oldest, sickest patients will be penalized while the those that dump their problems on others will be rewarded.
This is a another extension of the victim philosophy which is driving patients to the courts. No one wants to understand that some complications are not due to negligence, but due to many other factors outside of the provider’s or hospital’s control.
I am afraid we are just seeing the first step in this process…it won’t be long before Medicare refuses to pay physicicans (as opposed to just hospitals) for care it deems to be due to a “complication.” This will only serve to drive a bigger wedge between providers and the sickest and riskiest patients.
Perfectly logical, but like every other effort to regulate an art through a centralized beaurocracy, the law of unintended consequences will not be violated.
In a fixed price system like medicare, where the only way to increase revenue is to increase the volume of services, bad care is more profitable than good. You not only spend less time providing it (for the same fixed reimbursement) but you also get to treat (or pretend to treat) the complications. The only payment system that rewards good care more than bad is one in which those who can plausibly claim superior care can demand higher fees for their services.
For the lack of this, the quality of American medicine is being progressively eroded to the extent that fixed-price systems (Medicare, medicaid, monopsony private insurance) take more and more of the market.