Hospitals To Face Lower Medicare Payments Over Infections And Injuries

Hospitals To Face Lower Medicare Payments Over Infections And Injuries

By Brian McCurdy, Senior Editor

As the federal government cracks down on nosocomial infections and injuries, one-quarter of the hospitals in the United States will reportedly lose some of their Medicare funding.    

For a year starting in October, 761 hospitals with the worst infection and injury rates will see a 1 percent decrease in their Medicare payments, totaling about $330 million, according to Kaiser Health News. The news service notes that in 2011, the Centers for Disease Control and Prevention estimated that approximately one in 25 hospitalized patients acquired a nosocomial infection, about 75,000 of whom died.    

Hand hygiene is a crucial, yet frequently ignored, tool to prevent infection in hospitals, according to Warren Joseph, DPM. He will carry his own alcohol hand foam with him in the hospital and use it before going into a room, after leaving a room and after working on the computer or chart.    

Similarly, Kazu Suzuki, DPM, CWS, asserts that hand washing or applying Purell alcohol gel in between patient contacts is the most effective tool against hospital acquired infection. His hospital has reminders inside every elevator and in employee parking lots for staff to use Purell on their hands. Epidemiologists will watch and warn the staff if they are not observing the proper contact precautions, including wearing gowns and masks to treat some patients, according to Dr. Suzuki, who is on the medical staff of the Cedars-Sinai Medical Center in Los Angeles.    

“I do believe the hospital management has to buy into the idea of keeping the clinicians in line and observe these methods rigorously to achieve the lowest infection rate possible,” says Dr. Suzuki.    

In Dr. Joseph’s experience, hospitals actually monitor staff (including physicians) through the use of “spies” on the floors. These spies collect the data and calculate the percentage of staff obeying proper protocol, numbers that are reportable to the state, according to Dr. Joseph, a Fellow of the Infectious Diseases Society of America.    

How can hospitals prevent infections? Dr. Suzuki acknowledges that surgical site infections are a fact of life, noting that even “clean” orthopedic surgery carries an approximately 1 percent post-op infection rate. He cites many clinically proven methods to lower hospital-acquired and surgical site infections, such as clipping the hair rather than shaving hair before surgery, keeping the body temperature as normal as possible during the surgery, or applying a portable negative pressure device over certain complex incisions.    

Dr. Suzuki feels it is up to the state and federal government to enforce the concept of evidence based medicine in infection prevention, saying no patient should suffer from a hospital-acquired infection that physicians could have prevented with simple hand washing.    

“Our patients come to our hospital to ‘get better,’ and I feel it is unfortunate that some of our patients expressed to me that they are afraid to go to the hospital because ‘I would get sicker once I get admitted to the hospital,’” says Dr. Suzuki.

Which Bunionectomy Procedure Is Most Effective At Load Sharing?

By Brian McCurdy, Senior Editor

A recent study in the Journal of Foot and Ankle Surgery weighs the Lapidus bunionectomy against the chevron bunionectomy in terms of effective hallux valgus correction and load sharing of forefoot pressure.    

The study focused on 68 patients, equally divided into undergoing either a Lapidus or chevron bunionectomy. Both procedures facilitated radiographic improvements in the mean intermetatarsal and hallux abductus angles, according to the study. The authors concluded that the Lapidus arthrodesis and chevron bunionectomy each provide correction for hallux valgus deformity. However, they note that the Lapidus had a greater influence than the chevron on the load sharing distribution of forefoot pressure.    

Study lead author Christy King, DPM, notes that at her facility, all of the surgeons who performed the Lapidus and chevron procedures “are comfortable with the technical aspects of both procedures.”    

How do patients fare postoperatively following the Lapidus and chevron surgeries? Both the Lapidus and chevron patients are typically happy with the outcome and both do well in the long term, according to Dr. King, the San Francisco Bay Area Foot and Ankle Residency Program Assistant Director and Assistant Research Director. She notes the Lapidus typically requires a longer immobilization period and can classically carry an increased risk of nonunion or delayed union in comparison with a chevron bunionectomy. Although there were no nonunions or delayed unions in the current study, Dr. King co-authored an in press study revealing a nonunion rate of less than 2 percent for early Lapidus weightbearing.

Can Plantar-Pressure Based Orthoses Prevent Diabetic Foot Ulcer Recurrence?

By Brian McCurdy, Senior Editor

A recent study in Diabetes Care asks whether in-shoe orthoses, designed based on foot shape and barefoot plantar pressure, could have a positive effect in preventing sub-metatarsal head diabetic foot ulcers in those with peripheral neuropathy and a history of prior ulcers.    

In the randomized study, 66 patients wore experimental shape- and pressure-based orthoses and 64 patients wore standard-of-care orthotics. The study concluded that shape- and barefoot plantar pressure-based orthoses were more effective than standard-of-care orthoses in reducing the recurrence of sub-metatarsal head plantar ulcers, but did not significantly reduce the recurrence of non-ulcerative lesions.    

David G. Armstrong, DPM, MD, PhD, says the study supports what podiatric physicians have known for a long time: the need to measure what one manages and then measure it again. As he notes, the results of the study hopefully will lead to DPMs being required to measure pressure to better follow patients who are in remission from their diabetic foot ulcers.    

“Bringing objectivity into something that is and has been inherently subjective is not only welcome but essential at this point,” says Dr. Armstrong, a Professor of Surgery at the University of Arizona College of Medicine and the Director of the Southern Arizona Limb Salvage Alliance.

In Brief

Anacor Pharmaceuticals recently announced that the U.S. Food and Drug Administration (FDA) has approved the New Drug Application for tavaborole topical solution 5% (Kerydin). The company notes Kerydin is the first oxaborole antifungal approved for the topical treatment of onychomycosis of the toenails due to Trichophyton rubrum or Trichophyton mentagrophytes.