Delirium can happen despite textbook medical care. The only way to truly avoid it may threaten access to care:
It appears that the surest way to avoid incurring CMS’ proposed financial penalty for delirium occurring in the hospital would be to avoid admitting sicker patients who are most likely to become delirious. This, of course, is a perverse incentive that could make care less accessible for those who need it the most, and would violate hospitals’ fundamental mission to care for the sick.
The Happy Hospitalist also chimes in.
{ 5 comments… read them below or add one }
Delirium is a VERY COMMON and usually unpreventable, unpredictable event, not a “never” event.
By making these very sick (and expensive) patients anathema to practicing physicians, are we seeing a closet form of enforced euthanasia by truly unscrupulous insurers?
Ed Sodaro MD
I wonder what methodology they used to come up with that? I am not opposed to the idea of not paying for certain generally avoidable complications, but they are off the mark on delirium. When I worked as a consultation psychiatrist, it was probably true that much, perhaps most, of the delirium that I saw in consultation could have been avoided. But that is why I was being consulted–the attending knew that he may be missing something. When delirium was a clear result of the patients general medical condition as in the vast majority of cases, they didn’t ask for my input.
Sure it could have been avoided sometimes by a more careful substance abuse assessment, or better attention to detecting undiagnosed mild dementia-and low-balling the dosages of some of the less critical drugs. But you have the patient you have and usually have the to give what you have to give.
The real result of this will be patients with clear delirium that is never labeled. Like a lot of other rules, the liars and game players will get paid while the honest people lose money.
If they enact anything like that, they are basically begging me to let the 80 year old demented nursing home patient with a broken hip die. They might as well go directly back to the ECF.
Delirium- nah, she’s just agitated.
DVT- nah, probably just strained her calf or slept on in wrong.
CMS will reap what it sows.
You will also hear the line, “I don’t feel comfortable taking care of that patient at our facilty.” So every pleasently demented hip fracture or Diabetic with a history of DVT will be sent to the nearest Level 1 teaching facility and trauma center