Beginning October 1, 2008, Medicare, and many health insurance companies, will no longer pay hospitals for the additional services needed for patients who suffer from “never events.”

Never Events, as defined by the National Quality Forum, are those events which should never happen to a patient.  There are 28 errors on the list ranging from wrong site surgeries to drug errors to crimes committed by medical professionals.

Not included on the list from the NQF are HAIs (hospital-acquired infections).  There may be many reasons for this, but there are many groups and organizations that believe HAIs like MRSA, C.Diff and VRE SHOULD be included on the list.  Many of them, although not all of them, are preventable.

Regardless of what the left hand is doing (NQF), the right hand of payers (Medicare and many insurers) have decided that these infections will no longer be covered.  That means that any hospitalized patient who contracts, or at least presents with, an infection during a hospital stay may not be charged for the extra cost of treating the infection, nor will the hospital be paid by Medicare or many of the health insurance companies.

I don’t have the expertise to say whether this is right or wrong.  On the one hand, I believe it’s absolutely necessary to force hospitals to figure out ways to decrease the numbers of patients who contract these infections, estimated to be upwards of 5 million patients per year.

On the other hand, I know that sometimes patients arrive with pre-existing infections that may be apparent when they are admitted.  Can they be tested upon arrival?  Of course they can — although some hospital personnel point out how expensive that is, and that insurance won’t cover that either.  I have no doubt that there will be some problem for patients that crops up from this new ruling.  Hospitals will refuse to admit patients at risk, or they will discharge them too early so they can — at least in the paperwork — ignore an infection just as it begins.  Hospitals will do whatever they need to to protect their *sses — and it will be at the expense of patients.  Unintended consequences, all based on money.  What else is new?

During the past few days, a dialogue has taken place… wait… make that a diatribe…. on the blog of a certain “buckeye surgeon” where complaints and barbs have been thrown at a newspaper reporter who wrote about this October 1 date for reimbursement stoppage.  On just about the same day, the Wall Street Journal printed an article by Dr. Betsy McCaughey, founder of RID (Reduce Hospital Deaths) that gave some statistics about hospitals that have addressed infection problems — and have successfully reduced their numbers, one (claims) to 0 patients over a span of years.

So –I pulled some quotes from Dr. McCaughey’s WSJ article and posted them to the blog — and you would have thought I was the devil-incarnate…. whoa!  A regular lightening rod!  All those doctors so quickly turned their ire on me.  And I thought angry patients got worked up!  They can’t hold a candle to posters like “white coat” and “anonymous” who — God forbid — don’t even use their real names.

No — they attacked me one after the next.  In fact, it began when I suggested that SOME hospitals were actually trying to help patients!  SOME hospitals are actually asking their doctors and personnel to adhere to a checklist that — (you won’t believe this) — actually prevents infection!

Oh — one even attacked me for not being grateful that I was misdiagnosed with cancer.  She told me I should not have been upset at the misdiagnosis — I should have been relieved that I didn’t have it.  (My standard reply, which I didn’t bother with is — “gee — you didn’t get hit by a car today.  Are you relieved and grateful?”)  Of course — what on EARTH does this have to do with infections?  I’m not sure.

What’s the bottom line?  What can we learn from this?  Honestly — I do NOT believe that including HAIs on the list of never events Medicare and some insurances will no longer pay for was the right approach.  While some infections could have been listed and it would have been helpful, instead I think Medicare has only thrown down the gauntlet for hospitals to go underground.  Patients will pay the price in even worse health problems.  We must be more vigilant and be prepared to stand up for ourselves and our loved ones, and once October 1 rolls around, that will be even more difficult.

What the Trisha-bashing on the Buckeye Surgeon’s blog has shown me is that when we patients begin to stand up for our NEED for decent healthcare, we become the enemy.  The point I tried to make on a couple of the blog posts was that I think patients and providers need to remember that we have the same goal — improved patient care.  But those folks didn’t want to go there.  They just wanted to bash me.

I pray none of them is ever hurt by a medical error.  I hope none of them ever suffers at the hands of a medical practitioner who is probably just in a big hurry because he doesn’t get reimbursed well enough for his work.  I hope they don’t lose a loved one, like I did, after she acquires MRSA.

But mostly I hope they will stop taking their frustration out on the messenger.  Afterall — excuse me — I THOUGHT we all had the same goal?

Don’t we?

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I had lunch today with a long-time friend, Mindy.  (No, of course that’s not her real name…) It’s been at least a year since we saw each other, and probably two since we had a long conversation.

My heart broke as I learned that her daughter, Lindsay (not her real name either) has, for lack of a better description, gone right off the deep end.  I’ve known Lindsay since she was only 11 or 12 — a bright, articulate and curious adolescent.  In more recent years, I knew Lindsay had developed eating disorders.  She is anorexic and bulimec, and is almost 18 years old.

Lindsay’s eating disorder is only one in a long list of problems she has acquired during the past few years.  She has abused drugs, has been in trouble with the law, and is dealing with some other mental health issues as well.

Her mom, Mindy, has struggled to do the right thing, but of course, as parents, we never really know if we are doing the right things by our children.  Mindy shared some aspects of how they have tried to help Lindsay.  Her findings sounded remarkably like some of the advice I share with you on occasion.  It bears repeating, with this different light.

At one point, Mindy contacted programs for girls with eating disorders.  There are at least four of them within 150 miles of where Mindy and Lindsay live. Some are day programs.  Others are residential programs.  Mindy contacted them all — in fact, visited them — and learned that each one happened to be exactly the program Lindsay needed!

At least, that’s what they each told her.  Each program was different, using different approaches to treatment, but according to the people who ran them (and, do I need to add, the people who would be paid by Mindy’s insurance if Lindsay attended their program?) each of their programs was just right.

This should sound vaguely familiar.  I’ve blogged before about doctors who advise us about treatments, but may have ulterior motives for their recommendations. My misdiagnosis odyssey was my first experience with this.  I accused my oncologist of insisting I begin chemo because it was the only way he could make money from me.

My friend Max was told he needed prostate surgery and he should undergo a minimally invasive procedure.  After studying options on the internet, he learned that an even less invasive, and less trying form of surgery using a robot might work even better.  So he asked his surgeon about it, and was told that NO, he certainly didn’t need to have the robotic surgery…. then learned later that the surgeon he was asking didn’t know how to do the robotic surgery.  Hmmmm…..

The literature is rife with examples of doctors making money, sometimes discreetly or even under the table, from the treatment recommendations they make.  Whether they are investors in specific medical device manufacturing companies (think artificial body parts) or drug prescriptions (think subsidies from pharma drug manufacturers) — the recommendations being made to you may have more to do with lining a professional’s pocket than your treatment success.

One disclaimer here — I do not believe a doctor would knowingly recommend a treatment that would harm you just to make money.  But, I do believe there are times when, all else being almost equal, the first consideration would be money, followed by your success or with little regard to the expense to you.

For example, if you had a history of knee pain, your doctor might recommend your knee be replaced today, even though therapy might help you for another year or two.  Of course, he wants to replace it using the brand that pays him a kickback fee.  But you don’t know that, nor does your insurance.  And don’t forget, most of these artificial joints have a shelf life — meaning — if you get one two years earlier than necessary, you will need a new one two years earlier, too.

It seems to be true enough in healthcare — whether we are talking about brain surgery or eating disorders — that we need to find someone who can help us consider the evidence much more objectively.  That means we either have to find someone who can help us with all the options, or — even preferably — someone who won’t handle any of the options.  In Max’s case, he was able to find a surgeon who did both the minimally invasive surgery AND the robot surgery.  He told Max the robot would serve him quite well.

And in Mindy’s case — she was able to find an advisor in anothor city who had no ties whatsoever to any of the available programs — one who knew all about the other programs in that 150 mile radius, and who was able make a recommendation based on that knowledge.  The advisor wasn’t in a position to benefit her own program, so she was able to make a more objective recommendation.

Let’s learn from both scenarios.  If you are in a position to need difficult, invasive or long term treatment, make sure you get at least a second opinion.  Then find someone who either can provide you with ALL the choices, or someone who doesn’t have a stake in ANY of the choices to help you get more objective advice before you make your final decision.

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Last January I posted three stories I had been told, all within a few days of each other, about patients who had acquired MRSA in the hospital and had been revictimized by the system that would not treat them, listen to them, or help them get well. Over the next several days, I was condemned, chastised and even told my allegations were off base…

Today another comment was left on that post, and it compelled me to follow up.  Because as disgusted as I was with the reaction to that original post, I am truly even more upset and disgusted by what this poor young woman wrote to me today….

Here’s the synopsis:

The original post was called “MRSA:  Patients Ignored, Left to Die.”  It told three stories.  The first one was about a young woman who had (to that point) been in the hospital for almost a year because her MRSA could not be controlled, and because the hospital was not taking the steps needed to help her.  Update:  The woman, Tameka, has since died, 11 months after acquiring the infection. To those of you who suggested the story was untrue — I suggest you explain that to the woman’s family.

The second story was about Maxine who had been struggling to find anyone to help her or her family get someone — anyone — to treat them for the MRSA they had all acquired.  A number of commenters told me that could not possibly be true…. yet since then I have received at least a dozen additional emails reporting exactly the same thing — plus the comment that was left today tells the same tale.

Further, a good friend, someone I work with frequently and who works in healthcare, is dealing with this exact scenario with her father.  After knee replacement surgery, and despite a spiking fever and a swollen red surgical site, her father’s surgeon kept telling her and her dad, “Looking good!”

Update on Maxine:  I have not heard from her in many months.  I don’t know if she has found treatment, and I don’t know if she has gotten past the infection.

The third story was about a young man, Jeff, who had been treated by an ungloved doctor in an emergency room who, when Jeff asked him to wash his hands and put on gloves, told Jeff that the “MRSA thing had been blown out all of proportion.”  I know that most of you reading this will be incredulous — but I can almost guarantee there are some of you who think that doctor is right.

Why the follow up today?  Because today I heard from Sarah who tells a very frightening and sad tale about the MRSA her mother acquired after surgery a few weeks ago.  I’m going to reprint her comment in its entirety below — or you can read the original here.

In effect, Sarah’s mother’s experience is a compilation of the three originals.  The very sad part is that this story is repeated MILLIONS OF TIMES A YEAR.  The CDC’s numbers are 1.7 million infections per year, but Dr. Betsy McCaughey, director of RID (Reduce Hospital Deaths) proves in this piece that that number is way too low.

So here we are, almost 8 months later, and infection rates and experiences have gone from bad to worse.  What will it take to pull those denial heads out of the infection sand?  How difficult can it possibly be for a provider to wash his hands before he touches a patient?  Why can’t hospitals test patients for MRSA before they are admitted, then care for them appropriately if they already have the infection?

Patients — my advice to you is two fold:

First:  take a can of lysol with you to the hospital.  Spray anything you will touch, or that will touch you.  TV remotes, telephones, bed rails, bed linens — any type of surface can harbor infections.

Second:  Don’t let anyone in a hospital or doctor’s office touch you without washing and sanitizing his/her hands first.  Do NOT go to any hospital that does not allow 24 hour visitation — then make sure there is someone with you 24 hours per day to be sure that anyone who touches you washs and sanitizes his/her hands first.  Plus, make sure any equipment has been sterilized — stethoscopes, IVs — even the IV ‘tree’ that holds those bags of liquid — spray it !

Of course, there are a dozen other steps you can take — but these are a start.

Yes — I know I get wound up — I can’t help it.  There are so many, many safety problems patients have to contend with when they access healthcare.  Not all of them are so easily preventable, but most of MRSA is.  It costs almost nothing for a healthcare provider to wash hands.  It costs next to nothing to test a patient as s/he enters the hospital, then to manage the care in a place removed from other patients who are not infected.

………………………………

Here is Sarah’s post.  You can find the original here.

My mom who lives in Fresno California was recently diagnosed with MRSA. She got it after a surgery. She started to have pain and was throwing up. Her doctor that performed the surgery was in denial that she had MRSA.  Before my mom had the surgery she was scared that she was going to get MRSA. She has Lupus so her immune system is not good.  She did have the surgery and 4 days later she got violently sick. The doctor would not run a test to see if she had it.

The hospital doctor had to step in and order the test and four days later sure enough the test were positive.  After that her doctor finally came by to see her ( which he had not been back to see her since she first got ill and she had requested to be tested for MRSA ) he called her some unkindly names and refused to treat her. Everything happened in front of the hospital staff. He is the one who did the surgery and now he is REFUSING TO TREAT HER!  And the scary thing is that he had orders for her to have a catheter put in her.

The hospital doctor of course did not put a catheter in her.  The hospital doctor had to treat her and the doctor for disease control is also treating her.  They discharged her after 3 weeks in the hospital. So don’t tell me that MRSA is no big deal and don’t tell me that doctors and staff will not refuse to treat someone.  I know that by law they have to but that does not mean that they will.  They will come up with some kind of reason of why they can’t.

Not everyone can be treated by text book. In my moms case she already had a bad immune system you would think that after knowing my moms medical history that it would make sense to test for MRSA before having the surgery. Now after being out of the hospital for 1 week she started to throw up and was having pains again.  Since she can not find a doctor that will treat her she had no choice but to go to the ER. The staff there was rude! She informed them that she has MRSA and that she currently has an open wound and she also has a vacuum that is sucking out the drainage in her belly.

she was also throwing up and they laughed when she asked them to wear gloves before touching her. Her arms were wet and moist and the triage person did not care to wear gloves even if it was to turn her arm a certain way. She then asked if they have a separate waiting room to put her in and they again laughed and said you have to wait in the main waiting room like all of the others.

Why wouldn’t they have a room for contagious people that have MRSA that is currently vomiting? Or what happens to people who have chicken pox and they sit next to someone like me who is 30 years old that has never had chicken pox. What happens to the people who have a weaken immune system and they sit out there with the healthy sick people.

My mom waited out in the waiting room for 4 hours and she ended up leaving. The next day her home health nurse made her go back to the ER because she has lost 20lbs and was still actively throwing up. She went in thru triage and immediately was sent back to a room. She is still in the hospital and they did find 3 other pockets that is filled with fluid and they need to be drained.

I understand the MRSA is different for people who are healthy. They usually can bounce back. But what about the ones who have a weak immune system.  And by the way my mom is a clean freak. So what happens when the bloggers like the ones who are on attack and are in denial of how serious MRSA really is start to blame the patient on poor hygiene when it is the hospital staff and the hospital itself that laughs when they are requested to wear gloves. And if you have ever seen some of the staff that cleans the hospital do you think they really take that much pride in cleaning. I know people who use to work sterilizing the equipment. What a big joke of workers they were. Needless to say they no longer work there. They were given the job because their mom was a head nurse and no one had the balls to say that person did not perform her job well because you do not want to have any conflict with her mom who was one of the head nurses.

This all is bad.  My mom is only 54 years old she looks terrible and who knows how much longer she will last. I wonder if those other bloggers work in the medical field.

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I’ve added another guest post this morning — one that will break your heart, too.

John T. James, PhD, a dad — and now a fixer — posted about his son Alex, a seemingly healthy 19-year-old college runner who one day collapsed, was hospitalized, and died a few weeks later.

The problem is, of course, Alex should not have died.  He didn’t die because his body couldn’t handle his medical problem.  He died because his doctors couldn’t handle his medical problem.

Dr. James has written a book called A Sea of Broken Hearts — you’ll likely want to pick up a copy once you’ve read what he has to say. He’s on a campaign to improve patient safety and establish a national statement of patients’ rights, something that does not exist.  (Most are surprised at the lack of standard patients’ rights, but that’s absolutely true.)

One more reminder that life is precious — and if we don’t advocate for ourselves, and protect ourselves from healthcare, we may not survive long enough to right this deadly system.

Read what Dr. James has to say.  Get angry.  Then work toward being a fixer yourself.

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