“Never events” to be eliminated-by checklists and nonpayment

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Hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) should never happen, if only hospital workers practiced rigorous hygiene, writes former New York lieutenant governor Betsy McCaughey. In fact, “for most infections, the only acceptable rate is zero.”

Litigation over such infections, she predicts, “will cause the next wave of class-action lawsuits, bigger than the litigation over asbestos.”

In the meantime, Medicare will stop reimbursing hospitals for the treatment of certain infections, and hospitals will also be barred from billing patients.

“The evidence justifying Medicare’s new policy is compelling,” McCaughey writes. Beth Israel Medical Center in New York City has gone 1,000 days without a central line bloodstream infection in the cardiac care unit. The key was spending $30,000 to implement a checklist that doctors and nurses must follow. This is claimed to have saved $1.5 million in treatment costs, and priceless lives.

Other hospitals have also reached the goal of zero central line infections. “We have the knowledge to prevent infections. What has been lacking is the will” (Wall St J). 8/14/08

Blue Cross/Blue Shield and other insurers will follow the lead of Medicare in refusing to pay for a lengthening list of “never events,” including catheter-related urinary infections, hospital injuries, bedsores, and severe post-operative chest infections (Kansas City Star 7/16/08).

“What will happen, of course,” writes Dr. Lawrence Huntoon, “is that hospitals will implement protocols to test for bedsores, minor cognitive deficits, and infections on admission.” The threshold for identifying these conditions will be very low. It is likely that the cost of the testing will far outweigh any savings to insurers from refusal to pay for treating hospital-acquired conditions. “In essence, hospitals will assure that ‘never’ events don’t occur—on paper.”

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  • Judith L. Tharp

    Also, this will discourage any admissions of people for severe community-acquired MRSA also, for fear of any spread while hospitalized. I foresee many transfers from ER’s to larger hospitals to avoid admitting to the local hospital people with MRSA sepsis, large abcesses, etc. To accomplish that, criteria for transfer will be creatively massaged.

  • Adam I. Harris, M.D.

    The enemy of “good” is “better”. If one is always forced to strive for “perfect” then something else will be less good.

  • Dr. Z. Herschman

    Though the cause is noble the method is flawed. As infectious organisms become resistant in the community and more prevalent, there will be a move to control this with general social enforcement of state mandated hygeine practices society wide. We will see a growth of punitive measures against physicians that admit infected patients or have them on their service. The result will be aggressive “benign” neglect of the unfortunate patient that is even at risk for developing any sort of infection with the goal that all patients that do make it to a hospital are not ill enough to develop any sort of such problem. There will also likely be a spate of disability claims or other litigation from hospital workers who are deemd to be carriers of the resistant bacteria. There is no end in site.

  • Physician

    A hospital is giving patients used inhaler (non-for-profit hospital) that could transmit MARSA. what could you do to stop the hospital from continuing this practie without facing the hospital rath and agression that could cause total destruction of the doctors professional career?

  • David S Wishnew, MD

    Sure, it’s the doctor and/or hospital and its personnel that are responsible for all the in-house nosocomial infections. EXCEPT…all those family members who fail to don gloves,gowns,caps,and gloves to visit patients. And, I have never seen any family member wash either before entering or after leaving a patient’s room. And, of course, the patients who wander the corridors, despite posted infection precautions. So, the doctor who examines the patients washes, while every non-medical personnel fails to do so; yet it is the doctor who is spreading the infections. I doubt it!

    The idea of process improvement via legislation and regulation is inherently flawed. What process improvement does is to try and regulate human behavior. I really don’t believe that you can do that. You can change behavior through education and example, but not by simply decreeing a different behavioral action.

    And the proof of the inherent flaw…why, the government, of course. Process improvement has been an integral part of our system for years, and look at where THAT has gotten us! But what will happen, as evidenced by the government, is that we will further increase the bureaucratic morass we find ourselves in. And, of course, this will lead to further expense. And again, the doctor is at fault for driving medical costs. I am just fed up with it all. Common sense has flown the coop.

  • Thomas Eaton

    In a perfect government world, all physicians will be responsible for all illnesses, and given the task to heal without compensation. Think of the praise the government shall reap!

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