Hospital-borne ailments face Medicare...

Hospital-borne ailments face Medicare budget ax

There are 38 comments on the The Indianapolis Star story from May 22, 2007, titled Hospital-borne ailments face Medicare budget ax. In it, The Indianapolis Star reports that:

Medicare says it might no longer pay for many of the mistakes made by hospitals.

Join the discussion below, or Read more at The Indianapolis Star.

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adele in baton rouge

Zachary, LA

#21 May 23, 2007
this idea is just incremental rationing of health care. cms or medicare cares nothing about patients, just their bottom line. if you want quality health care you need to get the gov't and lawyers out of the business of trying to practice medicine. the more regulations that are imposed on hospitals, physicians the less time there is for true patient care. patients themselves need to be more responsible for their health. everyone who thinks the gov't can mandate perfect results in hospitals is just fooling themselves. socialism never works & just dumbs down the society.

Indianapolis, IN

#22 May 24, 2007
I am happy to hear this since being disabled by an epidural steriod injection for sciatica, diagnosised wrong, wrong product used depo medrol a neurotoxing that is disabling patients all over the world check it out for yourself, there is no cure for this debilliating pain it is 24/7 called adhesive arachnoiditis the procedure and product glues your spinal cord nerves together, drug co knows this is happening product was first mfg in 1959 and an old drug fda is aware of this but will not stop it, and my husband took his life 2 months ago from pain associated with spinal stenosis, and was never given anything for his pain, and then was tested for a boil in his groin and was not called by the drs office for a follow up appt, and he thought he might have prostrate cancer so the medical profession gets what they deserve and much more I would never trust another dr no way, you are safer without taking drugs, i took over 33 in five yrs for this pain and none work so you live in pain the rest of your life, cannot walk far sit long stand long, bend lift, my husband was my caretaker so I lost my job, my quality of life and now my husband I am glad medicare is finally taking a stand on this it will save many lives, do not be fulled theire is a nurse shortage or a dr shortage this is what they want you and us to believe yes their might be a shortage according to them, but the only shortage is of a GOOD DOCTOR and try and find one do not believe all they tell you, check your condition out and your drugs and any procedure before proceeding ask questions be safe not sorry
Gaby S


#23 May 25, 2007
So, the hospital (which is a business after all) has the incentive to discharge the resident quickly BEFORE the complication develops, then readmit at one of their other facilities with a 'new' admit diagnosis, now worsened due to inappropriate discharge and lack of care.
What about SNF, HOme Health, Longterm Acute, will they not get paid either for taking care of these poor folks with bedsores and infections?
Another Nurse

United States

#24 May 25, 2007
If we are going to blame all of these hospital accuired infections on the hospital and staff errors, Hospitals are going to have to not allow families to visit the patient and not accept high risk patients for admission. I can't tell you how many times family members have come in without washing their hands. Tried to help and pulled out IV's, moved patients off their sides just after the nurse has rolled them to prevent pressure ulcers, or used the patient's bathroom because they couldn't wait to go to the public one.
Nurses are good, but we are not GOD! we can't control everything and the only people who will suffer from this are our nurses and our patients. There will be even more staffing cuts to pay for the number of collection agencies, lawyers and billing reps to collect the money from someone.

This is a TERRIBLE idea. If Medicare wants to cut costs, there are much more appropriate ways
Christopher Meriam

Northbridge, MA

#25 May 25, 2007
I am a surgeon, have been for more than 12 years. I have seen many changes, most for the better. However, don't be fooled here - this proposal is made to save the Medicare system which is going bankrupt, not to help prevent medical errors. For instance, if the surgeon and the hospital do everything according to standards, there are still a small percentage of patients who will get an infection. There is nothing in medicine that is 100% safe - I wish there were and that I could guarantee all my patients they won't have a complication. Despite all reasonable, and sometimes heroic, efforts, bad things can and do occur. This proposal saves the Medicare system to cost of all bad outcomes, from the look of it, even if the standards of care were met.
native 12 md

Hyannis, MA

#26 May 27, 2007
These conditions are not quite cosmetic.

Austin, TX

#27 May 30, 2007
An important concept is being missed in all of these discussions. If evidence based best practices are followed, and there are literly hundreds for most ailiments, and the outcome is not optimized, then by all means go after the provider. If, however, they are followed, and "stuff" happens, and after 30+ years in health care, "stuff" DOES happen, then chaulk it up to bad ju ju and pay up. This is not "cookbook" medicine, rather a science based approach to providing care. For example if a patient presents to the ER/ED with an evolving MI (heart "attack"), we know that recieving an aspirn, and a very well defined algorithm of inteventions inclusive of specific medications upon discharge, he/she stands a very good chance of long term survival. If, however, Dr. "God" chooses to treat his patient using HIS protocols, and the patient dies, he AND the hospital should be held accountable in both reimbursement and civil issues.

Elyria, OH

#28 May 30, 2007
Mom wrote:
This will eventually lead to other insurance companies refusing to pay for people that have to use their insurance for things like illnesses caused by obesity, mental illness etc.
This will only hurt the patient. They are at the mercy of the caretaker. If medicare doesn't pay who does the hospital go after? The patient gets the threatening letters. The patient gets the law suit. The patient eventually becomes homeless because of medical bills they can't pay.
This needs to be reconsidered.
That's incorrect. If a patient is covered by Medicare and a service is performed that is not covered by Medicare, or Medicare denies the claim, the hospital cannot bill the patient. That's the law. And, if Medicare finds out that the patient is being billed, the hospital can be sanctioned and not receive any Medicare payments for up to 5 years, which basically means, they're out of business.

Rochester, NY

#29 May 30, 2007
I have been a nurse since 1972, so I've seen alot of changes in the healthcare field. I've worked in acute care, pediatrics, allergy, and now, subacute rehab and longterm care. I presently am the Medicare case manager at a 600 bed rehab/longterm care facility. I myself acquired a nosocomial infection following c.section at a prestigious hospital in Chicago. I was very ill and required almost 2 wks. hospitalization. I definitely do not think what Medicare is proposing is an option that will work.
I think HMO's who manage Medicare programs will love not having to pay for hospital acquired infections or medical/surgical "mistakes".
Medicare may think this will force hospitals to improve their quality but it will not.
As with all else in life, going to a hospital involves risk. We must accept a reasonable amount of risk to undergo procedures/surgery. We all know that there are sick people in hospitals, so acquiring an infection, while regrettable, shouldn't be a huge surprise. Does this mean hospitals are off the hook? Of course not! That's why we have malpractice laws and redress in courts of law! And we all need to advocate for our own health.Speak up to providers and ask lots of questions. Don't take any statement as gospel - no one knows your body better than you do.

Corning, NY

#30 May 30, 2007
Just when you thought you've heard everything, the Gov't gets even more ridiculous; Do you think that these occurences are deliberate? The person immobilized by a massive stroke, who is unable to move, will be prone to bedwetting and its complications. Catheter seems the humane thing to do. Bed sores are also an accompaniment of such. We need better catheters as well as safer antibiotics to prophylax againt these occurences, but of course who is going to pay for these. Patients in my view are often discharged too early from the hospital, and with these new impositions, this will occur even more frequently. our efforts should be on the side of preventive measures which would reduce the numbers of strokes, heart attacks and kidney failure. But who will pay for this. We bemoan the dollars and cents which prevention would demand, then in the face of rising medical costs, by now in the trillions, offer absurdities as the solution.

Tampa, FL

#31 Jun 1, 2007
I find this deeply disturbing and vilely disingenuous of CMS. All of the conditions listed below are unfortunately very often a side effect of simply having a catheter inserted from a normally nonsterile area (exterior) into a normally sterile environment (bladder, blood vessel, lower airway). These infections happen in patients living outside the hospital whose normal anatomic barriers are so breached. In fact, drug resistant Staph infections are now more wide-spread in the community than in many hospitals. All hospitals have extensive Infection Control Policies (monitored by the Joint Commission on Accreditation of Hospitals, for one) to minimize these conditions. The numbers are reduced, but it is simply impossible to eliminate them entirely. CMS KNOWS this, just as they know how to get around paying for anything else they decide not to pay for. Nosocomial infections are expensive. No one wants them to happen. No one wants to have to pay for them. But CMS is the primary insurer for millions of sick Americans, and now they don't want to pay for their critical care?? Don't think that's because they're a bunch of bean counters that don't know medicine. Gosh, what a shocker that this sort of thing gets slipped in under Americans' noses under THIS Administration. And of course, there's an "opportunity" for public comment. Well, who told YOU about that?? If it weren't for IndyStar, do you think your DOCTOR would know about this? Do you think YOU would know about this? Of course not. This is the sort of stealth legislation that happens (they hope) while you're asleep. "Oh, but we had that public comment period. Nobody complained then." Wake up, America. It's YOUR government & YOUR HEALTH CARE. TAKE IT BACK.

1. Catheter-associated urinary tract infections.
6. Bloodstream staph infection.
7. Ventilator-associated pneumonia.
8. Vascular-catheter-associated infection.
9. Clostridium difficile-associated disease (gastrointestinal infections).
10. Drug-resistant staph infection.
11. Surgical site infections.

Tampa, FL

#32 Jun 1, 2007
Amen to that. If you want Walmart care, you get Walmart care.
Valedictorian-Surgeon wrote:
We will no longer be able to take care of Medicare patients because hospitals cannot afford to be financailly penalized for complications. The reason patients have bedsores is because there are no nurses to care for the patients because Medicare will not cover the cost of doing business. Anthem has the audacity to jump right in as long as they save money. None of these payers care about the patients or the profession. America, if you want discount medical care, you are going to get what you asked for. Your best and brightest will NOT go to medical school. When are physicians going to wake up and just say "no more!" to Anthem, Medicare, and the rest? We should not be contracted with ANY insurance company if Medicare based fees are involved. Enough is enough!

Indianapolis, IN

#33 Jun 4, 2007
Does this mean the hospital can still bill self-pay and commercial insurers? Will the patient be ultimately responsible for the reimbursement to the hospital?

Jacksonville, FL

#34 Jun 5, 2007
My mother has been in the hospital for a week now with a staph infection that she got from a heart procedure (stint) two week ago. They want to send her home with an antibiotic that she has to pay a $200 co-pay for. I have contacted the hospital and told them that she will not pay the money because this is due to their negligence. I am waiting for a call back before they discharge her. They told her that Medicaid would pay for some of it. What other options do I have with regard to this issue? If I tell them she IS NOT paying it, will they just keep her until its better? Its still not better and I worry about them sending her home...??? Please help! If you don't mind, email me at [email protected]
HMcB Frustrated RN

United States

#35 Jun 6, 2007
of the 13 listed problems, only 3 can be prevented - wrong blood, wrong surgery, retained objects following surgery. The other 10 are problems that develop based on the condition of the patient (poor nutritional state, frail skin,persistence at trying to get out of bed, and the rules on not using restraint). Medicare is trying to save $$$ but some complications cannot be prevented.
Lisa - Michigan

Brecksville, OH

#36 Jun 8, 2007
The more we allow government "interventions" into health care the worse the situation becomes. I have been a nurse for 18 years, and things only get worse with each addition of burecratic red-tape. Whenever decisions regarding healthcare are made by individuals who have no healthcare background, like medicare paper pushers, the worse the situation gets.If you think hospitals are in trouble now, and they are, wait until medicare reduces their payments even more. The other interesting note here is that medicare is primarily used by the elderly, and their numbers are growing rapidly. Might it be that the politicians are worried about their pocket books and not the health of our elderly population? Too often our society is eager to blame someone else for a problem rather than realize it was an unavoidable occurence or an honest mistake. We need to be careful about how we go about trying "to make things better".Hospitals do make mistakes but they also treat millions of people every year with astonishing outcomes. People are living longer and with age comes increased risk for health problems and susceptibilty to things like infections etc. Witholding payment to hospitals is not the answer to our problems!!!!!!

Chicago, IL

#37 Jun 25, 2007
I don't think that this is a good ideal as long as we are human being and get sick resistance is low and we are performing procedures thing are going to happen. hospitals are short staffed because of funding now and less money would just kill all the patients. no one is trying to cause any of these cc's but patients play a big part of this also.
Nurse Kay

Peoria, AZ

#38 Jul 25, 2007
So......a surgical patient is released early and eviserates when he/she gets home, from infection, who pays? Nobody? I have seen many early discharges where patient wounds have opened....and infected. Off to the infection program costing buckets of money....and nobody wants to pay? Now they will be billing the patient who is already broke. Health care is health care, whatever happens and should continue to be covered for the benefit of all. These types of patients will wind of dying because of lack of care due to no money. Nurses and doctors do their best to eliminate these problems but nobody is perfect. Why punish the patient?

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