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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Sunday, August 19, 2007

    You Broke It, You Bought It: The new Medicare denial model:

    In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.

    Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients.

    Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.”

    Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.

    It's probably reasonable to expect a hospital and surgeon to remove a left behind sponge at now added charge, but some of these conditions are difficult to avoid. Patients who require chronic urinary catheters, for instance, are notoriously prone to infection despite the best efforts to avoid them. And dying, chronically ill patients are prone to bed sores despite the best efforts to prevent them.

    Of course, refusing to pay for things does save money. But does it improve care? In this case, it's questionable.

    UPDATE: Physician Executive weighs in.

    UPDATE II: Readers of the New York Times weigh in:

    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.

    And another:

    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 8/19/2007 12:25:00 PM 2 comments


    Who else could have thought of such brilliant idea? Other than bureaucrats who have not taken care of pateints more than taking a glance and standing by them for photo-ops? Has anyone of these morons ever taken care of morbidly obese, malnourished, diabetic, immunocompromised patient who won't get out of bed because they can't and they don't have high tech beds to move them??? OMG, help us!

    By Anonymous Anonymous, at 3:50 PM  

    This sounds like an accident waiting to happen as America just gets more and more overweight. Having cared for overweight individuals before, it can be an uphill battle moving and taking care of them.

    By Anonymous Dara, at 4:44 PM  

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