I agree with the first one (pressure ulcers) for the most part, and definitely with the last three — these three items are sometimes called “never events” because they should never, ever happen (and rarely happen when a hospital has good procedures for staff communication and safety double-checks). However, denying reimbursement for catheter infections or staph might be taking it a little too far. Sometimes, these things just aren’t preventable, and it’s even possible that a patient could come into the hospital after already being exposed to such bacteria.

The new items CMS is proposing to add to this list are perfectly reasonable (and by that I mean rather preventable):

• Extreme blood sugar derangement
• A collapse of the lung resulting from medical treatment
• Staph infection in the bloodstream
• Surgical site infections following certain elective procedures
• Legionnaires’ disease

But a few just aren’t 100% preventable occurrences, or for some other reason, are silly to include. Why?

• Delirium — can occur especially in older patients and in those with dementia, and may appear with little warning or opportunity for prevention
• Ventilator-associated pneumonia – it’s actually not that easy to determine whether or not a patient truly has VAP or whether they have pneumonia from another source… some interesting papers have recently been written on why VAP shouldn’t be a quality measure of any sort 
• Deep vein thrombosis/Pulmonary Embolism — while DVTs/PEs are almost always preventable and are never a good thing, certain patient populations, such as those with cancer, are more susceptible to DVTs/PEs, and for some patients, anticoagulative therapy is contraindicated even after surgery because of other conditions, such as risk of stroke from bleeding in the brain
• Disease associated with Clostridium difficile infection — C. diff is nasty. C. diff is another thing that is almost always preventable. However, it is also one of those things that a patient can get by no fault of the care team. It can be related to a long course of antibiotics, is difficult to diagnose, and often can be made worse before it’s better.

Post from: EveryJoe

I wouldn’t believe for a second an insurance plan “rating” of a physician or physician’s office. Most of the ratings that do exist are based on primarily economic criteria, such as saving money through fewer referrals to specialists. The argument that secret shopper patients might be able to assess the quality of a physician’s practice is a thin one. The receptionist’s telephone manner and time spent in the waiting room are absolutely not proxy measures for quality. Even the claim that secret shoppers will assess how physicians manage relationships with patients is utterly ridiculous. Relationships with patients are something that become established over time, as a physician continually sees the same patients and works with them to address health care concerns. A secret shopper who calls a few times and pops in once or twice can’t begin to assess a practice’s overall performance in this area.

Post from: EveryJoe