Medicare/Medicaid covers about 45% of American health care through payment for the disabled and old folks. (I know, I know, "65 is the new 35", but you get Medicare anyway). The rules and payment strategies of Medicare are adopted by the entire industry, and what Medicare pays for and doesn't pay for, eventually is picked up by private insurers too.
Starting in 2008, Medicare has identified 7 conditions that they will not pay for if the patient gets them after they are admitted to a hospital. Some of them make good sense as a push for quality improvement and patient safety. These include blood incompatibility, objects left in after surgery and wrong site surgery. These events are 100% preventable. Others are difficult for even the best caregivers to prevent, like patient falls. Unless you tie a patient into bed (which will definitely affect your "customer satisfaction" scores), a wobbly person, somewhere, sometime, will fall.
Now Medicare has completely lost it with a list of additional "no-pay" errors. The new list, with my comments is below:
- Delirium (this is ridiculous. There are so many causes for delirium that have nothing to do with the caregiver. Delirium is an altered state of consciousness that may require treatment, not sanction)
- Surgical site infections following certain elective procedures (I'm OK with this one if they eliminate trauma, dirty wounds, or immune suppressed individuals, where infection may be unpreventable)
- Legionnaires' disease (this can happen in an isolated case, with the origin of the bacterium being a mystery. If a hospital has an outbreak that affects many, the health department should investigate. One incidence may have nothing to do with hospital acquired infection)
- Extreme blood sugar derangement (talk about vague. Too high? Too low?)
- Ventilator-associated pneumonia (yes, preventable)
- Deep vein thrombosis/pulmonary embolism (mostly preventable)
- Staph infection in the bloodstream (I presume they are talking about MRSA. I do not think this is 100% preventable anywhere.)
- Clostridium difficile infection (ridiculous. Anyone who is on antibiotics could get c.diff infection. Should we give up antibiotics in the hospital?)
- Collapse of the lung from medical procedure (a small collapse of the lung is a known risk of placing central lines. These lines are placed in emergencies all the time to save lives in hospitals and the only way to prevent them is to transport the patient to a fluro Xray and do the procedure there. I would rather take the risk of a small lung collapse than die during delay and transport)