"Patient safety isn't a new issue
just because government has new plans,'' said Ann Savin, a registered
nurse and director of quality management and performance for the Valley
Health System.
"We've known about pay-for-performance for a while now.''
Starting Oct. 1, the Centers for Medicare and Medicaid Services, or
CMS, will stop reimbursing hospitals for care related to giving
patients the wrong blood type, leaving objects in patients after
surgery, pressure ulcers, hospital-acquired injuries and other
preventable problems.
That means if a Medicare patient at Sunrise Hospital gets a bladder
infection after they've had a catheter, the hospital won't receive
payment for treating that infection.
"The headline caught my attention,'' Savin said. "Our commitment to patient safety is unchanged.''
The Valley Health System comprises Valley, Spring Valley, Summerlin, Centennial Hills and Desert Springs hospitals.
The federal government believes the no-pay list will save the agency about $190 million over five years.
Medicare's do-not-pay list seems like a drastic approach to
preventing medical errors, especially considering that insurance
reimbursements to health care providers are criticized as low; but some
health care providers say it's probably the best way to hold
accountable those who don't practice stellar medicine.
"CMS is tired of paying for people who are really bad. I don't want
to pay for people getting bad health care over and over again,'' said
Minta Albietz, chief nursing officer at Sunrise Hospital.
Like a number of hospitals in Las Vegas, Sunrise has implemented new
policies for staff and purchased technology to help reduce medical
errors.
The hospital recently stopped using a certain bed pad for patients
who suffer from urinary incontinence in favor of one that is less
irritating to the skin and is more comfortable, Albietz said.
The new pad, which is more expensive than the old one, is higher
quality and has a softer surface with an absorbent gel, Albietz said.
At Spring Valley Hospital in southwest Las Vegas, health officials
are paying attention to hand washing through a device known as the
"glitter bug.'' The device uses a black light that illuminates areas of
the hands, shown in purple blotches, that contain bacteria.
As part of the hospital's hand-washing campaign, patients are
encouraged to ask their attending physicians and nurses if they have
washed their hands, said Janice Austin, a registered nurse and director
of regulatory compliance at Spring Valley.
The campaign includes staff wearing buttons with the words "It's OK to Ask" on them. Pamphlets are also placed in exam rooms.
"Hospitals can have some really sick people in them, and there are
people coming in from outside,'' Austin said. "There's always the
potential for cross- contamination. Really, the first step for
preventing infections is to keep your hands clean.''
The focus on clean hands is to keep pneumonia rates among ventilator patients at zero.
Next year, Medicare will add three more errors to the no-pay list.
Ventilator-caused pneumonia is a candidate; so is drug-resistant staph
infections.
Savin said hand washing is key to preventing hospital-spread
infections, but hospitals also need help from patients and their
families to prevent medical errors.
For example, she said, patients who are too ill to walk should
follow their medical care provider's instructions to avoid falling.
Treatment for Medicare patients who fall while being treated in a
hospital is one of the eight errors for which Medicare won't be paying.
"Falls are a very complex patient safety issue. We always assess
everyone for the risk of falls,'' said Savin, who serves on a statewide
committee that focuses on patient safety.
"In most situations, we have to adjust their care based on those
risks. We warn them not to do certain things, especially when they are
in an unfamiliar environment. But there are always people who are
resistant to warnings.''
She said patients need to communicate with health care providers,
especially about their medical history and what medications they are
taking.
"We are going to do our part. We need the patient to do their part as well,'' Savin said.