Thursday, 4 June 2015

Surgical site infections not covered under CGHS reimbursement policy

Surgical site infections not covered under CGHS reimbursement policy
Dr K K Aggarwl

F.No.2-1/2012/CGHS/VC/CGHS(P): Dated the 1st August, 2013:
Subject : Clarification regarding admissible non-admissible items under CGHS.

e) Package rates envisage up to a maximum duration of indoor treatment as follows: 12 days for Specialized (Super Specialties) treatment; 7 days for other Major Surgeries; 3 days for Laparoscopic surgeries/normal deliveries; and 1 day for day care / Minor (OPO) surgeries.

However, if the beneficiary has to stay in the hospital for his /her recovery for a period more than the period covered in package rate, in exceptional cases, supported by relevant medical records and certified as such by hospital, the additional reimbursement shall be limited to accommodation charges as per entitlement , investigations charges at approved rates, and doctors visit charges (not more than 2 visits per day per visit by specialists / consultants) and cost of medicines for additional stay).

No additional charge on account of extended period of stay shall be allowed if that extension is due to infection on the consequences of surgical procedure or due to any improper proceed.

Hospital Acquired Infections may mean medical negligence also

Avoidable hospital acquired infections may involve medical negligence. HAI are infections that occur after 48 hours after admission.

As per CDC 100,000 patients died of HAI in 2002.  Over 20 lac people become ill as a result of HAI annually.

In March of this year, the CDC reported that 200 Americans still die daily as a result of HAI.

Staff members who failed to observe sanitary hand hygiene passed many of these infec­tions from patient to patient.

Until 2004, hospitals were not required to inform the public of spread of infection. Since that time, many states have required hospitals to report their infection rates to the public.

In the case of hand washing, the hospital that does not enforce firm infection control policies may be liable and may be found negligent.

A recent article in the New England Journal of Medicine found that, in 2011, after obtaining data from 183 US Hospitals pneumonia and surgical site infections were the most prevalent hospital infections accounting for 22% with blood stream infections comprising 11%

Organisms involved are clostridum difficile and Methicillin-resistant staph

It has become easier to link a particular infec­tion to a facility by sequencing the genome of the organism.

Risk factors include length of stay, severity of illness and immunity of the patient, cleanliness of the hospital, use of antibiotics policy and infection control measures.

Medicare also does not cover hospital acquired infection

The CMS ( Centers for Medicare and Medicaid Services') exercised its authority under section 5001(c) of the DRA by announcing that Medicare will no longer pay the extra cost of treating the following categories of conditions that occur while the patient is in the hospital: Surgical site infection after bariatric surgery for obesity, certain orthopedic procedures, and bypass surgery (mediastinitis); Vascular-catheter associated infection; Catheter-associated urinary tract infection etc.

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