Tuesday, August 21, 2007

Medicare Won't Cover Preventable Errors

I read an article in the USA Today newspaper yesterday and had to comment on it. It said that Medicare will stop paying the costs of errors that they deem preventable. "Hospitals will be expected to pick up the cost of additional treatments required by a preventable condition acquired while in a hospital.

The rule identifies eight conditions that Medicare will no longer pay for. Objects left in a patient during surgery, blood incompatibility, air embolism, mediastinitis, urinary tract infections from using catheters, pressure ulcers, and vascular infections from using catheters. This is supposed to help encourage hospitals to improve the quality of their services."

While this appears to be a great idea on the surface, has anyone thought of the ramifications of these actions?

Objects left in patients and blood incompatibilities are definitely preventable errors. There is no real excuse for those kind of mistakes and I agree that hospitals should foot the bill if those errors happen. But if a patient develops an embolus, how does one totally determine whether it would have happened by chance or mistake. Of course, if there is an IV tubing error or if someone mistakenly injected air into a line then it would be payable.

I don't agree with the idea that infections and pressure ulcers are completely preventable. We all know that regardless of how many times we turn a patient, prop their heels, they can still get pressure ulcers due to their co-morbidities such as diabetes, poor nutritional status, cancers etc. We all know that antibiotic overuse is making germs more resistant to therapy. Uncontrolled diabetics are the most difficult to heal and they get more urinary tract infections. Preventable error?

What do they think will happen when the lawyers come out of the woodwork with the lawsuits that can't be proven. The hospitals will be forced to pay out huge amounts of restitutions.

Where will they get the money to take care of these things? We are already stretched to the limits in relation to staffing in the hospitals. They will cut back staffing to make up the difference and the overburdened system will raise the costs of health care even more. The vicious cycle will continue.

How to fix this issue? I'm not sure, but some ways to tackle the problem are to ensure that nurse/patient ratios are safe. Nurses who can make better rounds and turn their patients more frequently, actually ensure that the patients are being fed properly, change urinary catheters more frequently, watch for confused patients to prevent their constantly pulling out IV lines (which is the main reason I've seen for infections in IV sites) without the use of restraints, can prevent these errors from occurring.
Another solution? Properly train new nurses and stop throwing them to the wolves with very short orientation periods. Explain to students the ramifications of proper care and what to really look for in real live patients with more clinical time in the hospitals.

Now that I've had my say, how about yours?

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