Comments on: Pneumonia, antibiotics, and CMS

By: GruntDoc

GruntDoc — Tue, 26 Apr 2005 06:29:25 +0000

I have had another idea.

If CMS pays, say, 40% of the billed charges, we should be willing to meet their targets 40% of the time.

Just a thought.

By: GruntDoc

GruntDoc — Mon, 25 Apr 2005 18:04:21 +0000

Ryan,
Our “Parent” organization, in an effort to maybe help healthcare but mostly to show ‘quality improvement measures that can be measured’ want blood cultures on 100% of patients with an admitting diagnosis of pneumonia. We have argued against this without success.

By: Ryan

Ryan — Mon, 25 Apr 2005 15:22:04 +0000

Our clock starts at the time of ED registration – (on the other hand, for their inpatients doctors have 4 hours from the time they write the diagnosis).

We have also been getting ‘dinged’ for not doing cultures. Apparently you are not required by CMS to do cultures (unless they go to the unit?), but if you do them they have to be done BEFORE antibiotics. And it seems that most of our medical staff is anti-EBM and wants cultures on EVERYONE. The brilliant solution is to get cultures and give antibiotics to EVERYONE with a cough…very cost efficient.

There was also some discussion of decreasing the time to 2 hours…

By: CHenry

CHenry — Sun, 24 Apr 2005 14:26:54 +0000

It will take maybe two county hospitals almost anywhere in the US to start refusing Medicare to create the kind of furor that will cause CMS to back down. When word gets out that cuts are affecting access to Medicare patients in hospitals, there will be significant blowback. Cuts to Part II don’t get that much interest, but failure of Part I is a whole other story.

By: EMDoc

EMDoc — Sun, 24 Apr 2005 13:22:25 +0000

I agree with Joe, at our site the clock starts when the patient walks through the door. During the busy winter season, the patient has already been in the ED 1-3 hours before being seen by the doc. If the 30% plus cuts that CMS has planned for us in the next 5 years occur then the breaking point is short on the horizon, if not already upon us.

By: GruntDoc

GruntDoc — Sat, 23 Apr 2005 21:35:18 +0000

Aah, William, now you’re talking.

Get loose from Medicare, and a huge amount of paperwork would be minimized, if not eliminated. All the JACHO mandated feel-good sillyness (dietary assessments in the ED, pain scales for everyone) would no longer be enforced, because JACHO would no longer hold the Big Stick. Not that those two examples are huge paperwork issues, they’re just top of the mind silly things we’re forced to do for everyone to keep JACHO accreditation, and therefore Medicare money.

EMTALA, the biggest unfunded mandate in healthcare, would stop in hospitals that no longer accepted medicare. Stabilize and transport to a medicare-participating hospital.

Some good would come of it: we could actually talk about cost and prices with our patients, making them better consumers of healthcare. I remain convinced the reason costs continue to climb is that the incured/covered patient is divorced from actual cost.

So, that’s what I’m wondering, too. Where’s the breakpoint where it’s no longer worth the hassel to accept Uncle’s increasingly meager reimbursements?

By: William

William — Sat, 23 Apr 2005 16:02:54 +0000

At what point will hospitals be forced to move to a “stabilize and transport” mode of operation in order to minimize losses due to medicare entanglements?

By: CHenry

CHenry — Sat, 23 Apr 2005 13:57:10 +0000

A groaning sound, a crack here and there, a sifting of plaster . . . and the building collapses.

By: symtym

symtym — Sat, 23 Apr 2005 09:33:33 +0000

Four Hour Rule

GruntDoc reviews an email we both received today from AAEM and I couldn't agree more. What I'm concerned about is the failure of the hospitals to understand that it is a system problem (the majority of the time having nothing to do with the p…

By: Jo

Jo — Sat, 23 Apr 2005 08:54:09 +0000

At our facility, the clock starts *at admission*. That means that (since we don’t have a formal ED) there can be a wait of an hour or more for a bed, on top of the waiting times for X-rays, VQs, etc.

I had a patient come in yesterday, in fact, with a preliminary diagnosis of pneumonia. It wasn’t until we’d run a bag of antibiotics and done umpteen things to comply with JCAHO standards that she got a VQ scan and we found the PE that had caused her chest pain and shortness of breath.

Makes me wonder how much money we charged her insurance company and how much time we wasted before we got a proper diagnosis.