[HSF] post op mediastinitis discussion

[Michael Firstenberg]

This is going to be a disaster.  By not willing to pay for a problem,  
CMS thinks that the problem will go away.  We think that these (and  
other major non-cardiac wound problems) will all end up at major  
medical centers because the primary surgeons will not take them back  
(in part since they and their systems will not get paid - and who can  
blame them since we do enough free work).  Although, from what I  
heard, you can still get paid for someone else's problems - which  
means all of the major medical centers will get all of these patients  
- gee, that sounds like a money saving plan.  Who is going to win  
out?  Of course the MedMal lawyers - that is a no brainer.
On Oct 2, 2007, at 11:47 PM, Douville, Chuck wrote:

> This discussion is relevant to our cardiac surgery colleagues  
> around the world, although it is a financial issue only in the USA.  
> CMS (center for medicare services), the agency responsible for  
> medicare healthcare funding in the US recently announced it would  
> no longer pay hospitals for costs due to postoperative  
> mediastinitis in cardiac surgery patients effective within the next  
> year. Despite perfect glucose control, antibiotic timing etc, my  
> own recent morbidly obese re-do AVR pt had his chest open 7 hours  
> due to difficult adhesions. S. epi wound infection on day 6  
> required opening his sternum, VAC therapy and IV antibiotics and an  
> extra week in the hospital. The only way to avoid the infection in  
> this pt that I can think of is to deny the operation to a 60 yr old  
> man with critical AS after previous CABG 6 years earlier.  I do not  
> believe the incidence of this problem can ever be zero. Thoughts?
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