May 14, 2012

Watch What Hospitals Do With MRSA

This is not unexpected. What was called MRSA for infections acquired by patients while in the hospital has now been termed HAIs (hospital acquired infections). I like the title given to the article in Medscape, Medicare Reimbursement Change Spurs Prevention, Work-Arounds.” Work-arounds is what we can expect from hospitals so that they will be reimbursed for something Medicare has deemed non-reimbursable.

Approximately half of the hospitals participating in a report published in the May issue of the American Journal of Infection Control increased their attention of how such infections (HAIs) were coded for billing. Instead of doing increasing measurers to prevent HAIs, coding for other billable infections was where they paid attention. It is no wonder that people are concerned about hospital safety since the hospitals care only about the profits they can accumulate.

I quote from the article, “"Our findings were generally positive, suggesting the policies have led not only to an enhanced focus on targeted HAIs with greater efforts toward surveillance and education but also to changes in practice from front-line staff as reported by infection preventionists," the authors write.

However, the results also include persuasive evidence of hospitals "gaming the system," according to Peter Pronovost, MD, PhD, director of the Armstrong Institute for Patient Safety and Quality and Johns Hopkins Medicine Senior Vice President for Patient Safety and Quality, Baltimore, Maryland.”

It is disturbing as a patient to see statements like “gaming the system.” This means that the coding is apparently working for them to obtain reimbursements they would otherwise be denied by Medicare. Read the article here.

I will now get into another even more disturbing aspect that this causing. I had intended on writing about this from another perspective. However, this does explain why the hospitals have through the American Hospital Association, sent a formal letter to the Centers for Medicare and Medicaid Services asking that delays be granted in meeting the “Meaningful Use” criteria that is scheduled to begin later this year.

The “Meaningful Use” came into existence as apart of a government program (the American Recovery and Reinvestment Act of 2009 (ARRA)) in which billions of dollars were set aside to aid medical providers shift from paper records to electronic records. When the providers could prove they had reached certain stages of meaningful use, they would receive reimbursement from the government to cover the expense of implementation.

During stage one of meaningful use providers needed to demonstrate that an interface was in place so patients could access their own medical records, via the internet, securely and privately. For hospitals, that access needed to be provided within four days of a patient's discharge. Read the AHA communication here in a PDF file. (Adobe Reader required)

Now that it is almost ready for stage two (starts Jan 2013), patients have asked for quicker access, meaning within at least 24 hours for theirs, their spouses, or their childrens records. We want to know what took happened, with whom, and how it happened. This is important if post discharge problems occur and we want to discern where the problems may have arisen from and who may be responsible. However, the American Hospital Association if attempting to delay these provisions and has asked for a 30 day limit for patient access. The AHA also wants three years to each stage instead of the two years currently mandated.

Fortunately, it is easy to figure out why they want the 30 day window. They want the extra time to “doctor” the records to “game the system”, prevent things from being available to the patients, and thus their lawyers, for events that should have been reported, but weren't. They need time to hide these and more. Yes, the hospitals are nefarious for misdirection and covering up what should have been reported. This is why when you are hospitalized, if you are able, record everything, or have another family member record what they observe. Hospitals count on this not happening because they know most patients do not have this mind-set.

Hospitals also need the time to recode and balance bill. They are sure to increase a number here and there for items seldom, if ever counted. Hospitals also have become adept at changing a coding number to get more money than should be charged. Therefore, if they deliver the records to you as soon as you are discharged, they will not have time to make all the changes they want. Plus an event that needs to be hidden may be in plain site. If by chance, the AHA request for 30 days is denied, you may end up in the hospital for a day or two more than normal while they adjust your records. Excuses for additional time in the hospital can be easily fabricated. Remember, the profit margin needs to be met for each patient as well as preventing future problems from your records.

Read the article here by Trisha Torrey. Then follow the links provided by here to others that are pointing out problems. I must also encourage you to read this blog from The Health Care Blog. This also takes you to other blogs that you should read.  Carefully follow the link to the letter from Trisha's blog.  I admit I cannot get it to work for me otherwise.

If you do not follow Regina Holliday, she has a lot to say about the current disaster in our hospitals and obtaining the medical records for her deceased husband. Her situation should make you desire to take action. Read these three blogs by Regina, one, two, and three.

If it takes some time to read all this, then you should have had time to consider your course of action. I have sent my emails to my congressional people.

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