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#97256 - 05/05/08 09:34 AM
CMS to add 9 hospital-acq'd conditions to no-pay
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Nae
Administrator
Registered: 07/16/98
Posts: 6464
Loc: Sanford, Fl, USA
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Under the proposal, hospitals still would be paid for hospitalizations but would not be allowed to code and charge for the following as "complicating conditions" if they develop during a patient's stay:
* Surgical-site infections after total knee replacement, laparoscopic gastric bypass and gastroenterostomy, or ligation and stripping of varicose veins.
* Legionnaires' disease.
* Diabetic ketoacidosis, nonketotic hyperosmolar coma, diabetic coma or hypoglycemic coma.
* Iatrogenic pneumothorax.
* Delirium.
* Ventilator-associated pneumonia.
* Deep-vein thrombosis or pulmonary embolism.
* Staphylococcus aureus septicemia.
* Clostridium difficile-associated disease.
CMS seeks to add 9 more hospital-aquired conditions to no-pay list
Edited by Nae (05/05/08 09:34 AM)
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#97260 - 05/05/08 09:55 AM
Re: CMS to add 9 hospital-acq'd conditions to no-p
[Re: Nae]
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14tonks
Member
Registered: 10/25/01
Posts: 6295
Loc: Only 3rd world country in US
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The whole insurance nonsense, government or private, just gets more and more nuts doesn't it? Let's see, we have this program or this insurance to pay for medical bills—-only we aren't paying anything if you get sick of this, that, or the other. Health insurance is turning to be the right word for it after all because pretty soon it isn't going to cover any kind of sickness. Eventually I think we'll all be able to acquire health insurance when we are born, and it will last until the first time we see a medical provider, after which nothing else will ever be covered for the rest of our lives. (Which is to say, unless you arrive by unassisted home delivery, nothing is going to be covered, ever.)
Edited by 14tonks (05/05/08 10:00 AM)
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#97265 - 05/05/08 11:02 AM
Re: CMS to add 9 hospital-acq'd conditions to no-p
[Re: 14tonks]
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tropsicleAfter
Member
Registered: 10/30/06
Posts: 2431
Loc: Vicksburg, MS
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Don't forget, tonks, that we will be required to buy this insurance and pay for it for life.
_________________________
tropsicle
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#97273 - 05/05/08 01:21 PM
Re: CMS to add 9 hospital-acq'd conditions to no-p
[Re: tropsicleAfter]
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14tonks
Member
Registered: 10/25/01
Posts: 6295
Loc: Only 3rd world country in US
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Absolutely; that goes without saying. It will be variable rate, too. 
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#97276 - 05/05/08 01:58 PM
Re: CMS to add 9 hospital-acq'd conditions to no-p
[Re: 14tonks]
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Glory1863
Member
Registered: 03/27/08
Posts: 273
Loc: Beyond Antares
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These are complications. These are things that should NOT happen. These are things that there should be nursing guidelines, clinical pathways, etc., available for monitoring and prevention. If a hospital is not doing all it can to prevent these problems, then why should they be paid extra for being screw ups? When it comes to the spreading of infection, for example, everybody SHOULD know how important hand washing is. You'd be surprised how often it isn't done. Just how many times should Dr. Ditzy-Futz be allowed to cause a pneumothorax because he's a big admitter or the hospital is named after his dad? No money seems to be the only sanction hospital administration understands. And no, if private insurance/government insurance won't pay, then they shouldn't be able to go after the patient for it either.
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#97277 - 05/05/08 02:13 PM
Re: CMS to add 9 hospital-acq'd conditions to no-p
[Re: Glory1863]
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14tonks
Member
Registered: 10/25/01
Posts: 6295
Loc: Only 3rd world country in US
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Have you actually been reading the lists of complications for which they will now never pay? There is no way to reduce the incidence of most of these to zero, and occurrences do not necessarily reflect either malpractice or negligence--yet, the hospitals will have to just suck up the costs, no matter what the reason for the problem.
This is why many hospitals are closing. Someone has to pay for the actual cost of providing care, or there will be no care. No matter how good your guidelines, how vigilant your quality control, in every field excrement sometimes occurs. Medicine is no different, only there the expectation seems to be that some things just will not happen, and if they do, medicine is peculiarly culpable. It's time to get real about expected results of medical care and interventions. This whole initiative has very little to do with improving quality of care or percent of favorable outcomes and everything to do with dodging costs. Everyone is trying to shift the burden of healthcare costs to someone else's shoulders in an endless game of musical chairs.
Edited by 14tonks (05/05/08 02:15 PM)
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#97290 - 05/05/08 06:16 PM
Re: CMS to add 9 hospital-acq'd conditions to no-p
[Re: Nae]
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haggis
Member
Registered: 04/29/04
Posts: 2638
Loc: Left Coast, FL
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Gee, they forgot MRSA infections, CHF and COPD exacerbations, pregnancy-related issues, and wound care. Give me another shift to remember what other goodies I see routinely to add to the list.
The irony is that I routinely see treatment free of charge for anything that comes across the border, from OB to organ transplants, as well as a large pool of drunks, crankheads, noncompliant diabetics, and mentally ill patients who make the circuit every couple weeks. Still not sure how that helps them treat the rest of us who just happen to have lousy or no insurance, but I suppose there's an angle where someone's making a profit. Obviously, our mistake is in getting bogged down with logic and morality because the world apparently operates on the basis of corporate profit alone now.
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