When a Surgical Site Infection Sends a Friend Through Hell

Cheryl Clark, for HealthLeaders Media , February 16, 2012

"SSIs remain a substantial cause of morbidity and mortality among hospitalized patients," the CDC paper said. "In one study, among nearly 100,000 HAIs reported in one year, deaths were associated with SSIs in more than 8,000 cases."

And then there is the issue of who pays for Muncie's much-extended care. Muncie and Jaffe are outraged that they and their PPO insurance plan, Anthem KeyCare 15, are having to pay an as-yet-undetermined share, with his co-pay for continued IV clindamycin, the drug that finally worked, until he is fully cured, at $62 per day.

"We believe that if a hospital breaks it, they have to fix it for free," Muncie said.

That's the way it is with Medicare. As of fiscal year 2012, the Centers for Medicare & Medicaid Services rejects higher rate payouts to a hospital "for the sole reason of treating a beneficiary who acquires one of the conditions on the Hospital-Acquired Condition list during a hospital stay."

"Surgical site infection following certain orthopedic procedures," are included, as well as surgical site infection of mediastinitis following coronary artery bypass graft and bariatric surgeries.

Anthem spokesman Scott Golden declined comment, saying he didn't have Muncie's Health Insurance Portability and Accountabilty Act release. But he said in an e-mail that "not reimbursing hospitals for claims submitted as a result of a hospital-acquired infection is a policy change that we have made across the board. However, the change may not yet be reflected in all hospital contracts. The contractual language is being added to hospital provider contracts upon renewal of those agreements."

Muncie and Jaffe are trying to spotlight the issue with "John's law," which would legislate greater transparency of hospital infection rates as well as specify who should pay for them. If hospitals knew they couldn't get paid by private plans, or anybody else, for extra care their mistakes necessitate, they might be less likely to make them, Muncie said.

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5 comments on "When a Surgical Site Infection Sends a Friend Through Hell"

jody jaffe (2/21/2012 at 2:23 PM)
According to the CDC, 70% of hospital acquired infections (HAIs) can be prevented. No one is saying all HAIs can be prevented, but 70%? That is shameful. So I have to disagree with Dr. Hirsch's premise that hospitals shouldn't be responsible for the costs of these HAIs until it can be proven they are all preventable. The bottom line is hospitals can do more, it just costs money. For example, Martha Jefferson Hospital, where my husband was infected and treated for THREE HAIs, defunded its two infectious disease nurses and refused to pay for an infectious disease doctor to be on its Infection Committee. According to Dr. Dan Sawyer, the infectious disease doctor at Martha Jefferson, infection rates went down when he was in the Operating Rooms, observing and gathering data. And the rates went back up when he stopped. Don't tell me Sentara, Martha Jefferson's parent company, can't afford to fund these positions. It posts net revenues of $3.5 BILLION and paid its CEO, David Bernd, $3.5 million in 2008.

Ray McEachern (2/20/2012 at 1:58 PM)
Rather than citing stats and making excuses, medical professionals must learn to take responsibility for possible mistakes that were the direct or likely cause of this type of infection. There should be a root cause analysis of this specific infection with the intention of finding how it could have happened. Unless there are documented procedures in this patient's record that establish beyond a reasonable doubt that all infection control procedures were followed during his entire stay, the hospital should take responsibilty. Just as airlines have black boxes to help determine cause when things go wrong, hospitals must have checklists and other records to prove their best practices were followed.

AHNguyen (2/17/2012 at 1:08 PM)
Physicians, nurses, and hospitals are not in the business of causing harm to patients. They do not celebrate complications/infections because they are getting paid extra for these events. This premise is idiotic. It is well known in the scientific community that a zero percent infection rate is an impossibility. There are myriad variables contributing to this process, most of which we do not have a complete understanding or comprehension in terms of identification, prevention, or intervention. We have identified the disparate variables contributing to SSIs. These include appropriate hair removal, skin decontamination, prophylactic antibiotics, body temperature, glucose control, and so forth. Adherence to proposed guidelines could reduce the incidence of SSIs significantly, but this rate is not ZERO. With regards to the author's claim of efficacy with preop washing, the current scientific data is "despite repeated demonstrations of a reduction in surface bacteria at the operative site using a CHG shower, meta analyses have shown only a NONsignificant reduction in wound infections in large number of patients." We all feel bad and horrible when someone has a bad outcome. However, without further information from this article, it is imprudent to assign accountability and culpability.




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