When a Surgical Site Infection Sends a Friend Through Hell
"SSIs remain a substantial cause of morbidity and mortality among hospitalized patients," the CDC paper said. "In one study, among nearly 100,000 HAIs reported in one year, deaths were associated with SSIs in more than 8,000 cases."
And then there is the issue of who pays for Muncie's much-extended care. Muncie and Jaffe are outraged that they and their PPO insurance plan, Anthem KeyCare 15, are having to pay an as-yet-undetermined share, with his co-pay for continued IV clindamycin, the drug that finally worked, until he is fully cured, at $62 per day.
"We believe that if a hospital breaks it, they have to fix it for free," Muncie said.
That's the way it is with Medicare. As of fiscal year 2012, the Centers for Medicare & Medicaid Services rejects higher rate payouts to a hospital "for the sole reason of treating a beneficiary who acquires one of the conditions on the Hospital-Acquired Condition list during a hospital stay."
"Surgical site infection following certain orthopedic procedures," are included, as well as surgical site infection of mediastinitis following coronary artery bypass graft and bariatric surgeries.
Anthem spokesman Scott Golden declined comment, saying he didn't have Muncie's Health Insurance Portability and Accountabilty Act release. But he said in an e-mail that "not reimbursing hospitals for claims submitted as a result of a hospital-acquired infection is a policy change that we have made across the board. However, the change may not yet be reflected in all hospital contracts. The contractual language is being added to hospital provider contracts upon renewal of those agreements."
Muncie and Jaffe are trying to spotlight the issue with "John's law," which would legislate greater transparency of hospital infection rates as well as specify who should pay for them. If hospitals knew they couldn't get paid by private plans, or anybody else, for extra care their mistakes necessitate, they might be less likely to make them, Muncie said.
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