Sunday, August 26, 2007
Even the most thoroughly researched preventive regimens continue to have substantial morbidity rates. Hospitals that already adhere to these guidelines (and there are many) will simply pay more and get paid less, without any improvement in their patient care.
Attempting to draw the line between truly preventable problems and those that are the result of prolonged therapy would seem to be a very slippery slope.
That said, I would happily endorse the proposed Medicare policy change, if we as taxpayers could hold our government and military to the same standards and refuse to pay for any of their “preventable” mistakes.
And a practical example:
So, I admit Mrs. Jones, an elderly patient of mine, to the hospital because she has pneumonia. Because of the stress of the infection, she becomes delirious, which puts her at high risk of falling.
In the interest of safety, I restrain and sedate her, which necessitates an indwelling urinary catheter.
One week later, despite meticulous nursing care, Mrs. Jones develops a urinary tract infection and a minor pressure sore on her back because of her debilitated, immobilized state.
My hospital administrator then suggests that I remove the restraints and the catheter and reduce the doses of her sedatives so that the conditions don’t get worse and our hospital doesn’t lose money.
Two days later, Mrs. Jones falls out of bed and breaks her hip.
How, exactly, has the new Medicare policy improved Mrs. Jones’s safety?
posted by sydney on 8/26/2007 08:17:00 PM 1 comments
Oftentimes Medicare's decisions are so simplistic or poorly thought out as to defy logic. This is, of course, another example. It seems they feel they can control outcomes based on payment. You wonder if there is any practicing physician input on most of these decisions. Anymore, I just shake my head and pray for the day I can retire.
By 11:31 AM, at