[HSF] post op mediastinitis discussion

[Donald Ross]

We all agree that no health funding system is perfect but you guys  
certainly have some crazies in yours.
Don
On 03/10/2007, at 2:18 PM, Michael Firstenberg wrote:

> 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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