A Key Turning Point on Hospital Acquired Infections
I’m back from two weeks vacation in Utah (what a place!) — with welcome news in today’s NYTimes front page story (click here) that the Medicare program, run by the Centers for Medicare and Medicaid Services, will stop paying for “the extra costs of treating preventable errors, injuries and infections that occur in hospitals…” In the multi-year campaign to raise awareness of and stop hospital acquired infections, this may well be the most significant and impactful step of all. Once Medicare adopts this policy, the bulk of private payers will certainly follow, the only question being how long it will take them. And state Medicaid programs won’t be that far behind either.
Changing the way we pay for medical care services is the most essential step/challenge in getting quality right. HCFA’s cost-control agenda we issued last March — click here for the report and see recommendations B1-7.
There’s been a gathering movement against hospital acquired infections for most of this decade. The real hero in this movement has been the Consumers Union and their Stop Hospital Infections campaign which triggered the passage of public reporting laws in 19 states. HCFA’s quality legislation would require public reporting of hospital acquired infections and so-called “never events,” and direct the Department of Public Health to work with hospitals to reduce infections as close as possible to zero — click here for info on our bill, scheduled for a public hearing on September 12th, 10am, before the Legislature’s Joint Committee on Public Health.
Here’s a sincere question for all the private insurers — in Massachusetts and elsewhere. Information on hospital acquired infections has been publicly available for years now. Have you been unaware of the problem of hospital acquired infections? Is so, how come? If not, what have you done about it before now? If you knew about infections and have not done anything before now, how come? If this issue doesn’t force some hard thinking on the part of our health plans, there’s something wrong:
Susan M. Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group, said, “Private insurers will take a close look at what Medicare is doing, with an eye to adopting similar policies.”
It has taken the consumer/patient voice and now the financing power of the federal government to bring this issue to the fore. The CMS action is the turning of the corner on infections. Time to start thinking about what’s next.
John McDonough
August 19th, 2007 at 10:14 pm
Welcome back, John.
Let’s just start by posting the data publicly and see what happens. If that were done, you might not need additional financial incentives of the sort being considered by CMS. (In fact, the article in the NY Times raises some interesting points about cost-additive behavior that could result from the latter approach.)
Interesting, isn’t it, that although people in MA seem to have trouble agreeing on what data to post and have used that as an excuse for not posting anything, the CMS is apparently ready to use existing data in a new way?
(By the way, at BIDMC we post pretty up-to date central line infection data based on the CDC definition: http://bidmc.harvard.edu/default.asp?node_id=8332. That seems like a good standard.)
August 20th, 2007 at 6:36 am
Please also read Zagreus Ammon’s comments on this topic at http://executivephysician.blogspot.com/2007/08/medical-errors-and-medicare.html. Whether you agree or not, they are worth considering.
August 20th, 2007 at 11:00 am
How would you persuade Tufts University School of Dental Medicine clinics to make available the infection rates?…
The Tufts dental medical center would benefit by being more open with patients.
August 20th, 2007 at 11:24 am
Hi John,
I agree that this is a huge step in a new direction, and I think it goes beyond just hospital-acquired infections. It’s the first real action by CMS that uses its considerable market power to fundamentally shift the current “cost-plus” paradigm of reimbursement. This will free commercial plans to do the same. Maybe I’m being naive here, but this policy change feels really big to me.
August 21st, 2007 at 8:12 am
While recognizing the difficulties in finding the source of nosocomial infections, these changes are a step in the right direction. CMS has appeared to be judicious in its choice of conditions covered under the new rules (only 2 so far, Vascular Catheter Associated Infections and certain Catheter Associated Urinary Tract Infections). If you read the exhaustive public comments on the proposed changes as well as the CMS’s response to the comments, I believe there is reasonable evidence that the recommendations shaped the final rulings.
I do agree with previous comments that said healthcare is science and art; that outcomes cannot be guaranteed. With that in mind, perhaps a strategy could be devised that rewards hospitals for implementing evidence based measures to cut HAI. This effort recognizes that hospitals cannot eliminate all HAIs, but all hospitals should demonstrate an effort to do so.
In any event, the first step is to measure HAI, which the CMS is doing. Again, that is a step in the right direction.
August 21st, 2007 at 1:26 pm
The MA Association of Health Plans agrees that more can be done to improve quality. Reducing hospital acquired infections is an important piece, but it’s not the only solution. Whether it is tiering, selective contracting, clinical guidelines, or pay-for-performance, health plans have been actively engaged in implementing a variety of initiatives to push for better quality from doctors and hospitals.
You mention that changing the way we pay for medical care services is the most essential way in getting quality right. Our industry has been doing just that as a way to drive quality improvement and was well ahead of the federal government in implementing programs that reward physicians that meet quality standards or who put in place measures to improve patient safety, such as reducing medication errors. If you want specifics on the various P4P programs in the state, check out MAHP’s Massachusetts Physician Incentives Guide at http://www.mahp.com/news/ig2006.pdf
Some of the ideas in your cost-control agenda – public reporting of Never Events and improving patient flow to reduce ER overcrowding – were bills we filed last session and again this session. We’re glad to have some company and that you’ve included the Never Events proposal in House Bill 2226 and Senate Bill 1277.
We plan to be there next month in support of those bills and look forward to participating as a coalition partner.
In the meantime, here’s a question for you. If you think that CMS’s decision to stop paying for the extra costs of treating preventable errors, injuries and infections that occur in hospitals may well be the most significant and impactful step to reduce hospital acquired infections, why not amend those bills to prohibit payment when those preventable infections occur?
August 24th, 2007 at 4:26 am
Skin infections at Lemuel Shattuck Hospital Geriatric Care Services.
Sanitation
A mouse appeared on the window sill in the patients’ room at Lemuel Shattuck Hospital Geriatric Care Services. Towels, linens and other things used for patients are put on that same window sill where there was a mouse.
Skin infections. Infection control.
Skin infections have developed from a lack in sanitary practices for patients. Better attention to infection control is needed to prevent skin infections.
November 20th, 2007 at 5:52 pm
[...] injuries and infections that occur in hospitals” beginning October 1, 2008. See the HCFA blog here. We hoped then that the CMS move would get the ball rolling, and apparently it [...]
July 31st, 2008 at 10:23 pm
I have been working in a residential treatment center for several years. in passing my mother who is an infection control practitioner was telling me about this very thing. as we all know that Medicaid and Medicare both set the presidency for the insurance companies, though will it affect the mental health sector too. should we be concerned? should we have a plan in effect? for both the answer is yes. however where can we start…
I am in a group that was formed by our organization to address issues as they arise. am I wrong to think that we should at least be prepared?
thanks
September 18th, 2008 at 6:31 pm
Hospital-acquired contagions account for about one half of all hospital complications. Therefore, we are dealing with a problem on a massive scale.
There are two basic pieces to learning the cause and control of this dilemma: (1) It is the nature of the beast - infected people go to hospitals because that is where they need to be. (2) Human behavior plays the largest role in the spread of infectious organisms.
There are identifiable standards of care to prevent the spread of communicable diseases in hospitals and to prevent infections of various parts of the body arising from sloppy technique. This is an area of provable negligence that often goes unnoticed.
April 21st, 2009 at 12:37 pm
I acquired a negative coagulase staph infection at the BIDMC in Boston during a surgery to mend a broken femur, and then spent 11 surgeries, 4 rounds of intravenous vancomycin (each lasting 6-8 weeks), and one and a half years trying to get rid of it. It’s interesting because I still became very close to my “team” at the BI who helped me rid my body of the staph infection and who ultimately saved me from amputation of my leg. I had wonderful doctors and some great nurses and am grateful to them. I had a total femur and knee replacement ultimately, but am still in physical therapy one year later. And, although the surgeons said I would always have a limp, i am spending 2009 in pilates, yoga, massage, personal training, and everything else I can do to make sure that does not happen. I only have a very slight limp now as it is, and my doctors are stunned. I suffered with the staph infection more than i did when i had cancer when i was 12 years old! And there were so many frustrations and problems at the hospital. Hospital acquired infections are becoming an epidemic, and I can’t even tell you how many mistakes I witnessed happening at the BIDMC. Not to mention visiting nurses, one of whom at partners home health care used a household wrench (not sterilized) to try to unscrew a piece of my PICC line while I was at home with a 102 degree fever (this resulted in E-coli in my blood the very next day, and no one at Partners ever took responsibility for it). I ended up taking charge of my own care and maintaining a very positive attitude and strong support group with family and friends. I would send my doctors countless e-mails and would not take “no” for an answer. I am now writing a book to tell other patients how to be their own best advocates. Because let me say this, NO ONE cares about your health more than you do. Furthermore, I find it ironic that after giving me a staph infection, my insurance company had to pay $500,000 to the BIDMC and I had to pay about $40,000 out of pocket to make myself better! Hospitals should have to eat the cost of ALL hospital acquired infections; perhaps then the rates of such infections would drop. There is no one person to “blame” when you get a staph infection, because who is to know for sure how you got it and who gave it to you? This way no one takes responsibility at all. In addition, human resources at most hospitals is a total JOKE. the most traditional response to most concerns and questions is: “I am sorry you feel that way.” It is so incredibly frustrating! Another note: I am a very assertive person by nature, and went to harvard college and harvard law school and so am very educated, and also financially independant, but how would someone not so lucky as myself fare in such a situation? I am pretty sure the answer is “not well at all”. –Dalia.