Now Hospitals Must Pay for Avoidable Complications

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Hospital staff, doctor's, RN, aide's are trained to document to the benefit of the facility they work for, rather than for truthfulness! In RN school the training is there, never lie because it will only cost you your license! If anyone thinks that they do not loose records, change them etc. even today? Come on! Look at the standard cheating among corporation's, to their stock holders across the board, in this country- finally being exposed. Dishonesty and deceit is everywhere. After my husbands hospital stay recently. I myself a retired RN. The RN wants to go get someone to do the job if feces is involved. The aide apparently now wants to go get housekeeping to do the job, and where does that leave housekeeping? I had to take care of almost all of his personal hygiene care! One aide was wonderful in helping me, when she was on duty! I pushed the nurses button for him and spoke if he had a need politely! The call button that they made sure was not anywhere near him. A confused patient! He had no bath at all, only bed baths I gave him myself & I had to stand in the shower with him per staff's instructions, so he would not fall? I was soaked & my shoes. I had to get linen myself, and change his bed when soiled, bathe him etc. He had laxatives to lower his ammonia level! Staff just ran period! This is the liver floor? After 7 days of no shave, my son's helped me get him shaved. Hospitals do not make decisions upon what is best for the patient, but upon how they can make the most money during the patient's stay. Even to the point of which medications can be used, that they can make the most money on? The liver doctor never explained anything, if I asked he became rude! Had knee surgery with almost no pain control after surgery! He really suffered, in spite of request for help. The Hosp. pushed for a Sniff unit (nursing home) stating he only needed IV therapy, even with unresolved issues that were life threatening and never documented! Discharge staff was unbelievably rude! He now has a MRSA (contact, not airborne) a nosocomial infection acquired from the hospital. Cellulitis on both legs that they never documented, discharged him with. Never put him on isolation for the MRSA, and never told me that he had it, so the family could take precautions. By ignoring the problems he may now have brain damage, that may not be reversible. He did not go into the hosp. with it!. Had him crying for five days, by refusing to talk to his power of attorney myself, instead of him. He thought they were going to put him in front of the hospital so I could just come and get him? The staff had my mother trying on a Sunday to find a Sniff unit per the staff's instructions. I was polite when asking for his care, but now the doctor filing in for his regular doctor has apparently destroyed his 10 year relationship with his primary care liver doc., as we now have a letter of discharging him as ever being his patient.

Lee Ford of OK 6:29PM January 23, 2009

The hospital acquired conditions that Medicare has focused on in this inital "pay for performance" effort were selected because they have been identified to be largely preventable through the application of appropriate "evidence based care" processes and procedures.
Yes...evidence based care requires multidisciplinary coordination among physicians, nurses and other caregivers. And that means "doing things differently" than we always used to. It also means investments in organization, infrastructure and process, and requires culture change. But when properly made, these investments can have a significant quantifiable positive ROI.
One client of mine that made such investments had approximately 1/4 of the incidence rate of the identified HACs than the national average. Had they experienced a higher rate, consistent with the national average, it would have increased their unreimbursed cost base by approximately $10 million per year.
Although most observers are responding to the potential revenue loss related to the new reimbursement scenario, the negative impact of these events on a hospital's unreimbursed costs is much more significant. As health care organizations invest in the quality improvements to avoid revenue losses, they will experience measureable related margin improvement.

Scott Hodson of 10:54AM October 18, 2008

Your article is way too simple minded.
UTI can be a complication of bladder catheter placement, but this is a known risk of bladder catheters. Bacteria can tract back alone the catheter infecting the bladder. Normal bladder voiding prevents bacteria from accumalating in the bladder. Patients requiring bladder catheters for many reasons, but the most common is that the patient cannot void on their own.
True, changing the catheter fequently will decrease the number of infections. This is not without cost:
1. nurse time to change catheter; 2. cost of a catheter kit; 3. risk of injury when inserting catheter; 4. risk of infection if catheter placed improperly. Yes, there is a risk of infection by just placing the catheter.
How about patients that are confuse or cannot tolerate catheter placement without sedation or medication? Did you consider the risk and cost of sedation. People die from sedation medication. This is a known RISK.
Your article is way to simple. I know, I have been in the healthcare business over 17 years. People come and go with ideas; most are useless and cost the system money. Too often people sit on a desk and make decision that are plain stupid.

rk of CA 12:06AM October 02, 2008

So, Medicare is not going to pay and hospitals have to try and perform better.
The UTI is acquired anyway. So, now what? The bill will arrive in the mail because the patient needed the extra antibiotics and length of stay increased.
Is the patient paying now?
If I am the patient and I get one of those infections, I will refuse to pay.
We will see how this pans out.

Lisa of NH 10:35PM October 01, 2008

Hospitals will be forced to discharge you asap, the sooner you are out of the system the less likely you will acquire post surgy infections welcome to the world of check in, check out see ya. later..
So many patients are housed in our hospitals because there is no such thing as avail. long term-secondary care facilities. We've all seen how they do things in cities like L.A., using taxis to drop off patients at homeless shelters.
More of it coming your way courtesy of those preaching how to fix things. Time to shave the fat off. Those fat wallet hosp. CEO's should all be ashamed. Cut their pay. Hire more in order to decrease your RN to patient ratios. Hire more ancillary staff so RN's have more help.
The sooner we start taking a real look at the problem the sooner we will stop the bleed. Why are patients so sick? Why are they so prone to secondary infections? ya think it has anything to do with our inability to provide adequate preventative care to all the baby-boomers.

of 7:15PM October 01, 2008

So basically this means more 1:1 care to avoid falls, more changing of catheters, etc. More "precautions" will yield to greater costs. Medicare needs to keep their cheap wallet open since they are already decreasing physcian reimbursement and setting the standard for what used to be good insurances in the past.

Chris of OH 4:25PM October 01, 2008

Who's going to determine if the hospital is at fault for these cases?
What if a member is discharged from hospital A with an unknown UTI, has an emergency later that day and goes to hospital B. Is hsopital B on the hook for the UTI?
What if a patient fall is due to patient neglegence? Is the hospital going to take the hit?
This is a great start but I'd like to know who's making the calls. These HAI's and never events are not always cut and dry situations.

Joe B. of PA 4:12PM October 01, 2008

"Why do more and get paid less?" Isn't that the atittude of most people these days? If they had really taken better care of the pacients, like they should, then there wouldn't be the extra work. So there ha ha. They are making more work for themselves by being lazy in the first place.
The whole point of being a doctor or nurse, is to HELP those in need. To actually help, is to provide service without expecting anything in return.

of TN 4:09PM October 01, 2008

Medicare is right about forcing hospitals to deliver better care.
On the other hand, Medicare is demanding more and not paying more.
Better care cost more.
Medicare, the public etc expect perfection, when perfection is desirable but not possible.

andres El Centro CA of CA 3:05PM October 01, 2008