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[动态] 美国医疗保险公司对部分医院感染等8类情况不再赔付给医院

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发表于 2008-10-4 15:59 | 显示全部楼层 |阅读模式

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2008年10月1日以后出院的病人,如果出现以下八类情况,保险公司将不再支付给医院相关费用了。2009年还将增加部分项目。
• Object left in surgery,手术留下异物
• Air embolism,空气栓塞
• Blood incompatibility,配血不合
• Catheter-associated urinary tract infections,插管相关尿路感染
• Pressure ulcers (decubitus ulcers), 褥疮
• Vascular catheter-associated infections,血管插管相关感染
• Surgical site infections – mediastinitis after coronary artery bypass graft 手术部位感染-冠状动脉搭桥术后的纵隔炎
• Hospital-acquired injuries – fractures, dislocations, intracranial injuries, crushing injuries, burns, and other unspecified effects of external causes 医院内获得的外伤-骨折,脱臼,颅内损伤,挤压伤,烧伤,其他外源性的影响

8项不赔付给医院的项目modern_healthcare_mar08.pdf (518.11 KB, 下载次数: 327)
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发表于 2008-10-4 16:12 | 显示全部楼层

回复 #1 icchina 的帖子

国医疗保险公司什么时间开始对发生医院感染者不再赔付给医院时,医院感染管理的春天就真的来到了,我们共同期待这一天的到来。:lol

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发表于 2008-10-4 16:46 | 显示全部楼层

回复 #1 icchina 的帖子

前一直在叫狼来啦!这真是狼来了!
我们院感人的压力会更大啦!院长的压力也更大啦!
但是,另外一方面说来:我们院感人的春天来啦!不过也这样的方式迎来我们工作的重视,显得非常的不地道!
:lol ;P
但是,我非常高兴:o

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发表于 2008-10-4 16:48 | 显示全部楼层
们实行了压力就大啦,压力也就是动力啊!!!
恐怕科室就不敢上报啦。

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发表于 2008-10-4 16:51 | 显示全部楼层

回复 #4 老朽 的帖子

朽老师,科室不报,医保办要亲自审阅病例的,不必担心。

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发表于 2008-10-4 17:54 | 显示全部楼层
然,我们也要查,我说的是主动性就差啦,要靠我们和医保办检查啦。

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发表于 2008-10-4 18:15 | 显示全部楼层

回复 #6 老朽 的帖子

是会加强责任心的,领导会重视感染工作的。:lol

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 楼主| 发表于 2008-10-4 19:36 | 显示全部楼层
https://bbs.sific.com.cn/viewthread.php?tid=9722&highlight=

今年卫生部关于医院感染管理的重要会议,领导给我起了个好题目《医院感染控制的新思路、新进展》,经过几天的反复思考,我决定讲这个内容,希望成为进一步转变我国医院感染管理体系的好机会。
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 楼主| 发表于 2008-10-4 19:42 | 显示全部楼层
原帖由 一枝梅 于 2008-10-4 16:46 发表
以前一直在叫狼来啦!这真是狼来了!

我们院感人的压力会更大啦!院长的压力也更大啦!

但是,另外一方面说来:我们院感人的春天来啦!不过也这样的方式迎来我们工作的重视,显得非常的不地道!
:lol ;P ...


其实这个思路部分来是于APIC,以前是美国感染控制学会,现在把美国去掉了,希望是国际化的。更名为the Association for Professionals in Infection Control and Epidemiology,缩写还是APIC。
也是把患者安全引起院长真正重视,引向深入出实效的重要举措。如果我们院感人员不积极介绍给国内行政官员和医务人员这个国际新做法,有谁更合适做这桩事呢?:lol
APIC Vision 2012-The Strategy

•        Leading APIC and the Profession to Its Preferred Future
•        Here are just a few APIC initiatives that are designed to move the profession forward and to secure our destiny as a matter of choice rather than chance:

•        Developing Standards for Public Reporting
•        APIC considers the need for standards and measures so important that the Association made a clear commitment in Vision 2012 to ensure that appropriate standards are set by which infection prevention and control programs are developed, managed and evaluated.  This means playing an integral role at all levels of our health care system—from the crafting of voluntary consensus standards to the development of state and federal legislation.  For example, APIC was one of the primary drivers behind the groundbreaking project being undertaken by the National Quality Forum to create a standard approach to the reporting of healthcare-associated infection (HAI) data. We are also working at the state level to shape public reporting legislation.  It is a key opportunity to build greater awareness of the profession and what institutions must do to prevent and reduce HAIs.

•        Building the Business Case for Infection Prevention
•        In April of 2006, APIC brought together a diverse group of thought leaders to explore the economics of infection prevention.  There is increasing evidence that HAIs cost many institutions millions in unreimbursed expense.  We are now working with key stakeholders to complete the business case. The goal is to shift the perspective of CEOs and CFOs from the traditional view of infection control as a cost center to the understanding that infection prevention can be a significant partner in profitability.  We will present outcomes from these various initiatives at this year’s Annual Conference and create a tool kit for members to begin to calculate the cost of HAIs in their institutions .

•        Addressing the Changing Environment
•        Also in 2006, we held a conference on surveillance technology. We thought it was important to help members understand how developments in surveillance technology could impact their practice, what options were available and how to leverage the use of surveillance technology to advance infection prevention and control within the institution.  We are also helping members stay abreast of emerging and reemerging diseases.  In August of 2006, APIC and Joint Commission Resources will co-convene "MRSA: A Time for Action" to present the most current advancements in the management of this increasingly challenging type of infection. During the conference, ICPs and health care leaders will present proven strategies to reduce MRSA, discuss the state of the art in MRSA surveillance and developments in some state legislatures toward requiring active surveillance. The conference will highlight the unique challenges of sports-related MRSA and best practices from the United States and the Netherlands.

•        Creating a Comprehensive Approach to Education
•        In 2006, APIC launched Education for the Prevention of Infection (EPI), the umbrella brand for what will become a comprehensive portfolio of educational offerings for the infection prevention expert.   The  EPI  curriculum will support the hierarchy of educational needs that the professional in this field requires from the novice ICP through seasoned expert.

•        Driving the State-of-the-Science
•        As part of Vision 2012, APIC will play a strong role in supporting research related to the prevention of infection and related adverse events.  Recently, The Research Foundation—a division of APIC—awarded a $100,000 grant to the Ohio State University Medical Center (OSUMC) to conduct a study on healthcare-associated infection (HAI) data. The study compared HAI data collected through traditional infection control surveillance methods and from administrative databases, which contain billing data and ICD-9 codes.

•        Playing a Leadership Role in Emergency Preparedness
•        Deadly natural disasters and the threat of an influenza pandemic continue to dominate news headlines.  As the first line of defense, ICPs need the most up-to-the-minute information to respond appropriately.  In a joint project with the CDC and SHEA, APIC is participating in building out a communications network of ICPs and epidemiologists that would operate in a variety of natural disaster situations. APIC is also a primary participant in the Working Group on Pandemic Influenza Preparedness, which has successfully advocated for pandemic preparedness plans and appropriations at the federal level.  As part of this effort, APIC will conduct a second survey in collaboration with the Trust for America’s Health to explore hospital preparedness challenges at the state level.   

•        Promoting Zero Tolerance for Healthcare Associated Infections
•        Finally, embedded in all of APIC’s initiatives is the commitment to zero tolerance for healthcare-associated infections.  As clearly articulated by APIC President Kathy Arias, MS, CIC, “Zero tolerance is not a number—it’s a culture in which health care providers strive to prevent as many healthcare-associated infections as possible. We may never eliminate every infection, and many cannot be prevented. But ICPs should accept nothing less than the very lowest rates of infection and actively promote zero tolerance for the adverse outcomes of health care.”  This goal is central to our preferred future and will inform all of our decisions as we make Vision 2012 a reality.
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发表于 2008-10-4 20:18 | 显示全部楼层

回复 #1 icchina 的帖子

是最近看到的最振奋人心的消息!
几天来一直有些郁闷, 关闭了心扉,不愿意发言回帖。终于有让我眼前一亮的信息,终于可以给我们疲惫的职业之路注入缕缕新风。

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发表于 2008-10-4 20:28 | 显示全部楼层
常重视的理念:零宽容对于感控事业是一个美好的理想境界!让患者在医院受到最小的伤害,就是院感人的价值观。

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发表于 2008-10-4 20:36 | 显示全部楼层

回复 #8 icchina 的帖子

谢!西安事件压的院感人透不过气来,您让我们看到了新的曙光和希望,令人振奋的好消息。:lol

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发表于 2008-10-4 21:24 | 显示全部楼层
前一直在叫狼来啦!这真是狼来了!
我们院感人的压力会更大啦!院长的压力也更大啦!
但是,另外一方面说来:我们院感人的春天来啦!不过也这样的方式迎来我们工作的重视,显得非常的不地道!
:lol ;P ... [/quote]
这次的狼确实离我们更近了不少,可惜狼依旧是另外一个国度的狼,似乎离我们又很遥远!
很希望这种国际化进程能赶快些,早点迎来院感人的“春天”。

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发表于 2008-10-4 22:04 | 显示全部楼层
次的狼确实离我们更近了不少,可惜狼依旧是另外一个国度的狼,似乎离我们又很遥远!
很希望这种国际化进程能赶快些,早点迎来院感人的“春天”。 [/quote]
愿我们的春天早日来到,届时大家会欣喜但不会发狂,因为还有大量工作要做

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发表于 2008-10-4 22:25 | 显示全部楼层

回复 #1 icchina 的帖子

盼着我国也早点有这项内容,否则领导仍不会重视.记得我院去年开技术质量委员会时讨论有关发生医疗纠纷后责任人的赔偿,我提出发生院内感染引起的纠纷也应该要医务人员承担赔偿比例,当时分管领导就说院内感染是允许发生的为何要赔偿?我说他们不遵守无菌操作规程和消毒隔离制度而发生感染没有责任?领导生气了不理我.
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发表于 2008-10-4 22:35 | 显示全部楼层

回复 #15 MMDJ 的帖子

医院感染管理工作的重要性,首先得让院长他们从主观上加强认识,才能把临床科室人员的院感意识提高,那我们的工作就顺利了.
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发表于 2008-10-5 09:58 | 显示全部楼层
(今年卫生部关于医院感染管理的重要会议,领导给我起了个好题目《医院感染控制的新思路、新进展》,经过几天的反复思考,我决定讲这个内容,希望成为进一步转变我国医院感染管理体系的好机会。)
期待老大的精彩讲座,参加一次学习班,觉的底气硬,说话也有分量:@ 知识就要不短更新,又该加油补充能量了:lol
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发表于 2008-10-5 13:57 | 显示全部楼层
原帖由 icchina 于 2008-10-4 19:36 发表
https://bbs.sific.com.cn/viewthread.php?tid=9722&highlight=

今年卫生部关于医院感染管理的重要会议,领导给我起了个好题目《医院感染控制的新思路、新进展》,经过几天的反复思考,我决定讲这个内容 ...



非常遗憾!和我们省内中医系统培训班冲突,无法到会聆听,希望会后能在论坛上学习!
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发表于 2008-10-5 21:52 | 显示全部楼层
希望老大的《医院感染控制的新思路、新进展》,能在院长的会议上进行讲解.院长们该改变一下观念了.
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发表于 2008-10-6 09:27 | 显示全部楼层

支持

胡教授:谢谢您,我已下载,准备在适当时候向院领导再渗透。虽然此项举措执行有难度,但我比较支持。早在刘振声老师主编的《医院感染管理学》中,就有这方面的宏观描述:“随着卫生体制的改革.......,尤其是医疗保险制度在我国的逐步发展和完善,治疗医院感染的费用已不会全部由患方承担,而将直接影响医院的收入”(P26)。我曾在自己的硕士学位论文中重点研论了“医院感染经济损失”方面的课题......,检索资料撰写论文过程中,曾宏观向有关院领导渗透过此方面的理念,现在好了,国际上有了具体内容,我们的工作有了让院领导重视的客观因素,我好欢喜,管理中太需要这样的信息了。

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