Sunday, August 19, 2007

It's official: Infections are bad

Emily DeVoto has a nice summary of the issues (and the link to the New York Times article) surrounding a possible Medicare rule that would withhold payments to hospitals when hospital-acquired infections occur. Zagreus Ammon also pitches in on the topic, as does John McDonough at Health Care for All.

17 comments:

Emily DeVoto, Ph.D., said...

Thanks for the shout-out, Paul!

Zagreus Ammon said...

Ditto.

I think the cross posting could yield some valuable discussions.

Anonymous said...

I am very ambivalent about this proposed rule; as an M.D. I guess I have to mostly agree with Zagreus' post. There are 3 reasons, as he pointed out: a) medicine is by no means the cut and dried science that CMS seems to think it is; it is very often not clear where an infection came from (think Clostridium difficile in a patient admitted from a nursing home). b)
With all deference to you, Paul, as a clear exception - most hospital administrators(and ALL hospital lawyers) that I ever associated with would take the attitude "let's prove it was community acquired" rather than trying to achieve the impossible - a zero rate of hospital acquired infections. It's just in their business-oriented, competitive nature, exacerbated by the habit of game-playing necessitated by current health care reimbursement anyway. And c) the flip side of any seemingly good idea is trying to implement it, and I don't see this as easily implemented without leaving a lot of innocent blood on the streets.

That said, the other side of my ambivalence is that this rule would, no doubt, greatly improve compliance with such things as hand-washing, the lack of which I find simply egregious.

I guess my opinion would be to try it first for sentinel ("never") events, which would clearly stimulate quality control programs, then use the data from that experiment to extend it to the more nebulous area of HAI.

Anonymous said...

Isn't that headline a bit flippant or sarcastic for being such a serious issue here? HAI's kill patients...

Paul Levy said...

That's the point of a headline. Please read my many posts below on the importance of this topic.

Anonymous said...

Anon 10:16:

I interpreted Paul's headline as sarcasm reflecting his frustration with some of his colleagues' reluctance to publish their own HAI statistics.
But his sense of humor does tend toward the sarcastic, I agree. Just like my brother thinks incredibly stupid movies are funny; all in the eye of the beholder. (:

Paul Levy said...

Uh oh. If people start to judge my humor, I am in deep, deep trouble. . . .

Patient Dave (deBronkart) said...

Re sense of humor and interpretation of headlines: when an author's audience is steadily growing, things sometimes need to be written so they'll land correctly in both the familiar ear and the total newcomer's ear. Takes some art.

Paul's usually rigorous about this, usually saying "As I've written before" etc.

Personally, I would have edited the head to be more like "It's official: infections are worth getting rid of."

(And I do agree with a lot of what anon 8:33 said ... those are just the obstacles that gotta be overcome as we fight the good fight.)

Paul Levy said...

Rule #1: Never put a present participle or gerund in a headline.

:)

Rob said...

Is it me, or does this just sound like another way to send a patient home who SHOULD have gotten better with a very large bill that s/he will be forced, under penalty or bankruptcy, to pay, because there is no recourse?

And don't tell me a hospital will write this off. Not if it's been formerly reimbursed. This is one of those reverse incentives that ends up hurting the one person it should help: the patient.

Sounds like No Child Left Behind. Reward the "good" schools by punishing the "bad" schools, only it's not even good and bad hospitals. It's good and bad outcomes, and, like NCLB, it's never going to be clear who's at fault, only that the innocent gets the shaft.

Release the lawyers, I guess. This is depressing.

Dr. Rob Oliver said...

rob,

the language of the statute prohibits hospitals from balance billing patients any non-compensated expenses for these events

Toni Brayer MD said...

I wrote a post on this on www.everythinghealth.net and I think it is fine for Medicare to put financial incentives in place to finally move the quality and safety agenda forward. We can talk for years (and we do) about the fact that our systems are not perfect, patients are too sick, hospitals are too poor, reporting events will disadvantage someone and on and on. It will require focus and cooperation with physicians, nurses,and administrators. Maybe we can actually acomplish safer care.

Anonymous said...

Brian Klepperer (from The Dr. Weighs In), substitute blogger for Matthew Holt, has just put up a post on this same subject on The Health Care Blog. I am sure it will generate a lot of comments from the characters who read that blog.

Paul Levy said...

Thanks for the heads up. The link is in my list of sites on the right side of the page.

Emily DeVoto, Ph.D., said...

The Globe's White Coat Notes blogreports that Harvard's own patient safety guru, Lucian Leape, is in favor...

SkiWiz said...

A Florida CEO I knew and respected once warned his medical staff that unless THEY take the time to monitor and improve the practice behaviors of their own, some else will.
Well, just like the docs I worked with in 1983 never thought the feds would really implement a PPS reimbursement program, the docs today think that they can continue to practice poorly and that no one will know.
I have spent my entire career in hospitals and applaud the new oversight activities. I just wish that physician reimbursement was tied to hospital reimbursement so that the hospitals wouldn't be penalized for poor medical decisions.

wefirst said...

There is one major omission in CMS' otherwise reasonable approach to linking reimbursement to reducing HAI: That is, the hospital will be penalized, not the physician!