[Dysphagia] Medicare changes

[sem at new-vis.com (Suzanne Morris)]

I see this as one of the most positive policies that we have seen in  
a very long time.   It is one that is likely to influence policy  
changes because it impacts the bottom line of finances and profits.    
I have been both astounded and appalled at the lack of action, media  
indifference and complacency at the statistics that suggest that at  
least the 3rd most frequent cause of death in this country is medical  
treatment itself.  That is, people who die from "correctly  
prescribed" pharmaceutical drugs or other treatments for a condition  
that is not directly related to the disease or disorder for which  
treatment in the hospital was rendered.  This new Medicare law begins  
to address this issue and gives some potential financial weight to  
identifying the causes of these problems more clearly and actively  
preventing them.   It seems like an excellent start.   The issues of  
dehydration related to thickening liquids, increased reflux causing  
pneumonitis/pneumonia due to automatically putting in a gastrostomy  
tube in the elderly etc. are some of the areas that certainly relate  
to decisions that we are involved with in working with clients with  
dysphagia.  What a wonderful opportunity we have to be more aware of  
how our decisions affect care and ultimately the bottom line that  
motivates most businesses (including hospitals, nursing homes  
etc.)!   Hopefully we will rise to the challenge and see the  
opportunities to provide thoughtful education to medical staff and  
rethink many of the procedures we have done simply based on tradition  
and a paradigm of care that seems less and less appropriate if we  
understand potential consequences and begin to reexamine what we know  
through research.

Suzanne
__________________________________
Suzanne Evans Morris, Ph.D.
Speech-Language Pathologist
New Visions
1124 Roberts Mountain Rd.
Faber, VA 22938
(434) 361-2285 ext. 5
www.new-vis.com


On Aug 20, 2007, at 8:58 PM, Irene Campbell-Taylor wrote:

> 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
> Exclusive Distributor:
> www.interactivetherapy.com
> _______________________________________________
> Dysphagia mail list: Normal and disordered swallowing information
> Dysphagia at dysphagia.com
> Manage subscription: http://lists.b9.com/mailman/listinfo/dysphagia
> Visit the new Dysphagia Web Forum: http://dysphagia.com/forum