[Dysphagia] Medicare changes

[vkargerslp at mac.com (Vera Karger)]

This discussion is illuminating and enjoyable.
I believe I'm with you on this, Suzanne.
Thanks.
Vera	 Karger, M.S., CCCS
Monroe, CT
vkargerslp at mac.com



On Aug 21, 2007, at 10:06 PM, Suzanne Morris wrote:

> 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
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