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Medicare/Medicaid Reg Changes Against Hospitals and Patients

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  I learned today in a management meeting at my hospital about some new changes to Medicare/Medicaid that I think everyone needs to know; especially anyone with a compromised immune system.

  As of October 1, Medicare/Medicaid will no longer reimburse hospitals for expenses related to the treatment of nosocomial infections (those acquired while in the hospital).  Once again, the government agencies are sticking their hand into something they should leave alone.  Obviously the thought process behind this is that if you refuse to pay for the expenses, then the hospitals will stop the infections from occuring.

  First off, the hospital has little control over the fact that certain populations of patients will acquire infections while in the hospital.  It does not matter where a patient is, hospitalized, at home, long term care facility, etc, certain patients are going to get infections.  Such patients would include: immunocompromised, patients with artificial airways or artificial ventilatory devices, patients with frequent iv/port/tube/drain access needs, patients who are convalescent, patients who are unable to tend to their own personal hygiene needs, patients with open wounds/burns, patients on multiple antibiotic coverage, patients who are non-compliant, patients who are malnourished, etc, etc, etc....

  Secondly,  a hospital can have the best laid plans, but it comes down to the individual workers to follow those protocols in order to prevent infections from spreading.  Some people do not follow because they are ignorant, apathetic, denialist, clumsy, or even defiant.  Every workplace/profession has these people, healthcare is no different.  And when you consider some providers who make right at minimum wage, then you get what you pay for.

  Thirdly, hospitals have no way of monitoring/controlling what visitors bring into the facility, and how they conduct themselves in private while in the patients room.  Again, see above paragraph for how/why visitors might infect the patient. 

  Here are some things that were discussed in our meeting today in order to avoid/curtail nosocomial infections and subsequent expenses for the treatment of the infections:

1.  Increase staffing, education, and programs on infection control.  Due to the added expense, we would of course have to increase hospital rates and charges.

2.  Greatly restrict the visitation policies.  There would be strict limiting on when visitors could come, how many could come (not just at one time, but throughout the hospital admission), the age groups that could come, the health of the visitors that could come, forcing all visitors to wear isolation gear when visiting an at-risk patient, denying visitation all together on at-risk patients, forcing patients and visitor(s) to sign waiver and acceptance for nosocomial infections, requiring that all visitation be strictly supervised (maybe even a 'no patient-visitor physical contact policy'), etc, etc.

3.  Refuse to accept Medicare/Medicaid patients.

4.  Refuse to accept patients in the high-risk category.

5.  Refuse to treat the nosocomial infection, as we are not responsible for treating a non-reimbursable condition that is not life-threatening and is not on your principle admitting diagnosis.

6.  Accept Medicare/Medicaid patients and/or high-risk patients only with a waiver and acceptance form signed, guaranteeing payment for nosocomial infections.

7.  Treat the nosocomial infection, bill the patient for it, and pursue the debt to the fullest extent of the law.

8.  Treat the nosocomial infections, and wait for a class-action lawsuit or legislative lobby to change the regulation.

9.  Treat the nosocomial infection and just eat the bill.

  All 9 of these options and combinations of these options, plus some, were discussed and considered.  It is a shame, that government meddling and it's attempts to "punish" hospitals is going to cause a poor ill patient to suffer.  The government rules and regulations already have hospitals hands so tied, it is no longer financially feasible for anyone to even invest in a hospital.  Without private enterprise/investments in hospitals, then they will have to be governent/public (ie: tax) supported; and thusly taxes will have to be increased.  At any rate, it is the diseased and the poor that will suffer, as they so often do.  To make things worse, most private insurance companies will follow whatever Medicare/Medicaid does.  So more than likely this non-reimbursement policy will be universal within a few years.

  So, watch out for yourself and those you care about when admitted to the hospital, to be sure that strict infection control policies are followed if you/they are Medicare/Medicaid.  Remember this new regualtion whenever you vote for candidates and laws; if you don't vote, you need to start!  Write your legislators and let them know how you feel about this new regulation.

  Last but not least, surely everyone knows that the majority of healthcare providers would never do anything to cause someone to get sick?!  Most of us put too much into our education, licensure, maintenance of licensure, and working all sort of bizarre hours, just to see that healthcare can be available to the communities where we live and serve.

I don't understand the ability to refuse treatment to a high risk person.  I am a high risk person.  What would you tell me?  Where would you send me?  I thought hospitals had an obligation to treat the sick regardless of ability to pay.

On point #5.  If you refuse to treat my infection since it was not in my original diagnosis, what happens if I come back to your door to get readmitted for treatment of an infection...thus making it my reason for being there the second time around? 

And if your hospital is thinking of doing this, then it is being discussed across the board.  So what?  Hospitals across the country suddenly decide to stop admitting Medicaid/Medicare patients?  How is THAT going to work?

I'm seeing a lot of 6's thru 9's in the future.  And how exactly would you get a "guarantee" that I would pay the bill through a waiver?  Yeah, I can sign anything...but if I ain't got it- I ain't got it.  What would be the course of action then?  Reinfect me if I can't come up with the cash?

Yep....6's thru 9's.  And especially 8's.

  A hospital does not have to accept any/every patient.  A hospital is responsible for treating an immediately life-threatening condition which will result in imminent death, and must treat a woman who is in active labor; regardless of their ability to pay.

  No hospital has to accept Medicare/Medicaid, in fact, some do not.  Some, have refused to comply with certain Medicare/Medicaid regulations (such as JCAHO accreditation), and only get Medicare/Medicaid reimbursement at a reduced rate.  While it is not financially conducieve to refuse Medicare/Medicaid, some do.  And note that, refusal of a Medicare/Medicaid patient without  just cause, can result in a hospital loosing it's right to collect money on ANY Medicare/Medicaid patient.  Just as you can opt out of receiving it, you can also be denied the right to collect it.

  Lastly, "I" am not doing any of this to anyone; and I know that you know that   ;) , but just wanted to say "Hey, it's not me that's doing this".  I am just reporting what was discussed in the meeting today.  I said that we would just have to treat the infections and eat the bill, do what we could to reduce the nosocomial rate.  I don't actually get any 'vote' on how they "our executives" decide to deal with the situation.  It was just a meeting in which we were vetted the information and asked to start brainstorming on soloutions to the problem.

I'm just saying this sounds like a disasterous decision.  Infections happen all the time in hospitals because,'s where sick people go.   ::)

I'm not saying "you'' specifically.  I'm just asking what would "you" (the hospital) say in such a situation.  What would become of all these people?  And sure enough- a lot of infections aren't life threatening.  But left untreated, a good many of them will become  So then wouldn't you be left with patients returning to your doors with even greater health concerns than they originally were discharged with?  Won't that really just snowball costs in the long term?

I'm not from a medical background, obviously.  I'm just rattling off the questions that immediately come to mind.

You are exactly right!!  It is a disastrous situation in the making!  It is what happens when regulators/auditors start meddling into affairs that they have no business trying to meddle with.  I was very hurt and angry when we were told that news today.  The cost of treating these infections can be enormous, and that is why they are refusing to continue paying for it, that, and as a 'punishment' to healthcare for "allowing" it to happen.  You are right, people get sick in the hospital cause that's where sick people go.  We having a saying up on the long term acute care floor, once we get a patient rehab'd to the point that we were hoping for, we say, "You better get them out of here before they catch a bug".  The problem is that these type of regulatory decisions aren't exactly 'laws'.  They get together a bunch of people that are paid to advise HCFA (Medicare/Medicaid) on ways to save money and etc, these people pass these regulations, and that is where it ends.  These regulations are not like laws that get voted on by our legislators, or by citizens.  So then the poor patients suffer.  Not because anyone asked the legislature.  Not because anyone asked you (a tax paying citizen).  Not because anyone asked me, assistant director of cardiopulmonary medicine and electroneurophysiology diagnostic laboratory.  All because the system is so huge, it's dying under it's own weight.  We all need to take into deep consideration the stance and interest political candidates have in healthcare in our country, and any few precious bills that we see on our ballots.


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