[Dysphagia] Medicare changes

[eripley at yahoo.com (Irene Campbell-Taylor)]

Medicare has announced it will stop paying hospitals for treatment of eight conditions that result from preventable errors, actually ?errors that could have been reasonably prevented.?.
  The conditions are catheter-associated urinary tract and vascular infections, pressure ulcers, objects left during surgery, air embolism, blood incompatibility, mediastinitis and falls. The agency said it is also considering adding other conditions, such as S. aureus septicemia, ventilator-associated pneumonia, and C. difficile-associated disease, to the list.
  Unless the conditions are present on admission, the extra cost of treating them won?t be reimbursed beginning with discharges occurring on or after October 1, 2008. The rules state that "The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication."
  While not immediately apparent, the one that most affects persons with swallowing dysfunction is falls. As long as thickened fluids are used extensively, we now know that, at least in the elderly, these lead to dehydration and certainly don't prevent aspiration.  This dehydration, in turn, commonly causes hemodynamic instability with repeated falls, often causing hip fractures, head trauma etc. The acting Deputy Director of Medicare is quoted as saying,? ?if a patient goes into a hospital with pneumonia, we don?t want them to leave with a broken arm.? The latter would be mild compared to the subdural hematomas, fractured hips etc. that often result in acute care hospitalization, increased infection and, at the very least, worsened condition if not death. Falling because of blood pressure fluctuations due to dehydration is one of the major hazards of the elderly in nursing homes. Knowingly contributing to it by the use of thickened fluids is, at the very least, poor
 management and it is only a matter of time before at least one family catches on and sues. 
  The next thing will be pneumonias resulting from unnecessary enteral feeding. 
  Let?s not continue these practices.
   


Dr I Campbell-Taylor
Clinical Neuroscientist
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