CMS regulations penalize hospitals for taking care of sickest patients

Implications: This article presents the new CMS guidelines that deny higher payments for the additional costs associated with treating patients for certain hospital - acquired infections and medical errors. While these are laudable goals, to assume that all infections are the result of poor medical practice is an oversimplification. The development of nosocomial infections also has to do with the patients disease processes such as diabetes, morbid obesity, immunosuppression, tobacco abuse, etc. While few physicians would argue against enforcing these rules for documented mistakes (medication errors, transfusion mistakes, and objects left in patients bodies), most recognize there is a certain baseline of these other infections which cannot be avoided. Hospitals should only be penalized when their risk adjusted incidence exceeds a standardized baseline.

Analysis:  

Once again CMS takes a good idea and turns it into punishment in order to save money rather than using this initiative to improve patient care.

Stating that all line infections or all mediastinitis is preventable is foolish as well as ignorant. This will make patients and administrators think any of these outcomes equates to poor medical practice. In fact they just as often reflect the higher acuity of patient illness that requires more invasive therapy. Obviously, institutions with high numbers of these adverse outcomes are suspect and should be investigated.

A better approach would be to reward those institutions performing at an exemplary level and only penalize those which are substandard. These exemplary institutions could highlight the changes they made to improve outcomes to the benefit of patients everywhere.

Institutions are likely going to limit services to high risk patients rather than risk a huge financial penalty for trying to provide them with the best care available.