Memphis, Tenn., hospital takes on protective measures after new Medicare rules

Daniel Connolly

Oct. 9, 2008 (McClatchy-Tribune Regional News delivered by Newstex) -- For the past several weeks, Emma Williams has had a new responsibility in her job at Delta Medical Center: The certified nursing assistant now applies special cleansers and creams to patients' skin.

Williams says patients tell her the creams feel good, but that's not the point.

The new creams help prevent pressure ulcers, painful injuries that can lead to death in extreme cases.

On Oct. 1, the federal Medicare insurance program for people over 65 stopped paying extra to fix pressure sores, also known as bedsores, and several other preventable problems that can develop in hospitals.

Using the special creams is one of many ways that Delta Medical Center is adjusting to the new rules.

The experience of the small, independent, employee-owned hospital at 3000 Getwell in Southeast Memphis illustrates how facilities around the country are enacting new policies in reaction to the rules.

"I would say every hospital is working on these major conditions that have been identified," said Chris Clarke of the Tennessee Hospital Association.

A key person in Delta's efforts is Debra Braddock, director of quality services. She said some of the hospital's initiatives are years old while others were created recently in response to the new rules.

Because Medicare doesn't pay for problems that weren't present when the patient is admitted, the hospital now runs tests to check for infections in patients who arrive from nursing homes with urinary and cardiovascular catheters.

Staffers also check the patients' bodies for sores.

"Now, even if it's 2 a.m., we're going to roll you over and look at your backside," Braddock said.

To prevent urinary-tract infections associated with catheters, the hospital uses special tubes impregnated with silver molecules.

They're also using a checklist, a prepackaged bundle of drapes and other materials each time they insert a central line, a tube that health care workers use to put drugs directly into a major blood vessel.

To prevent surgical-site infections, the hospital is monitoring the use of antibiotics before and after surgeries.

To cut the risk of transfusing the wrong blood type into a patient, the hospital is conducting multiple checks at each step in the process.

And to prevent falls, the hospital assesses all patients to measure their risk of collapsing. Risk factors include age and poor vision.

Those at high risk are identified through orange socks and warnings on the doors of their hospital rooms.

Braddock said the risk to the hospital's finances makes everyone focus on safety.

"I think it's better for patients," she said.

It's difficult to say how much money Delta could lose if it makes a mistake, said Stephanie Ousley, the hospital's director of patient accounts.

However, a hypothetical example from Medicare provides some help. Under the old rules, Medicare would pay about $5,400 to take care of a stroke patient.

If the patient developed a pressure ulcer in the hospital, Medicare would pay about $8,000. Under the new rules, Medicare pays only $5,400, meaning the hospital has to absorb the extra cost of healing the ulcer.

Tim Vogus, an assistant professor of management at Vanderbilt University, said the new rules may lead to quality improvements and could save the government money.

But Medicare requires hospitals to publicly report errors, which might encourage some administrators to cover up mistakes, he said.

"It's another source that's saying, 'We can come after you if you make mistakes,'" he said, adding that he wasn't speaking about Delta administrators.

Dr. Manoj Jain, medical director of QSource, a quality-improvement organization, was more positive about the changes.

"Before, a hospital could be performing extremely poorly on patient safety and it would not affect their bottom line," he said. "Now, poor-performing hospitals will be likely to lose money."

In the future, doctors are likely to face similar payment rules, he said.

Commercial insurance companies may follow Medicare's lead and stop paying hospitals extra for preventable problems, though Ousley said she hasn't heard from them yet.

She said the hospital was well-prepared for tougher quality standards, "as prepared as you can be."

Newstex ID: KRTB-0126-28641304