Comments on: Delirium as a "never" event? http://www.kevinmd.com/blog/2008/04/delirium-as-never-event.html medical blog Sun, 22 Nov 2009 14:15:05 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2008/04/delirium-as-never-event.html/comment-page-1#comment-85107 Anonymous Sat, 19 Apr 2008 05:30:00 +0000 http://clients.emmense.com/kevinmd/2008/04/delirium-as-a-never-event.html#comment-85107 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 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

]]> By: Anonymous http://www.kevinmd.com/blog/2008/04/delirium-as-never-event.html/comment-page-1#comment-85106 Anonymous Sat, 19 Apr 2008 05:26:00 +0000 http://clients.emmense.com/kevinmd/2008/04/delirium-as-a-never-event.html#comment-85106 Delirium- nah, she's just agitated.<br/>DVT- nah, probably just strained her calf or slept on in wrong.<br/><br/>CMS will reap what it sows. Delirium- nah, she’s just agitated.
DVT- nah, probably just strained her calf or slept on in wrong.

CMS will reap what it sows.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/04/delirium-as-never-event.html/comment-page-1#comment-85103 Anonymous Sat, 19 Apr 2008 01:38:00 +0000 http://clients.emmense.com/kevinmd/2008/04/delirium-as-a-never-event.html#comment-85103 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. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/04/delirium-as-never-event.html/comment-page-1#comment-85099 Anonymous Fri, 18 Apr 2008 23:54:00 +0000 http://clients.emmense.com/kevinmd/2008/04/delirium-as-a-never-event.html#comment-85099 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. <br/><br/>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.<br/><br/>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. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2008/04/delirium-as-never-event.html/comment-page-1#comment-85088 Anonymous Fri, 18 Apr 2008 18:13:00 +0000 http://clients.emmense.com/kevinmd/2008/04/delirium-as-a-never-event.html#comment-85088 Delirium is a VERY COMMON and usually unpreventable, unpredictable event, not a "never" event. <br/><br/>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?<br/><br/>Ed Sodaro MD 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

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