#1 Way to Decrease Health care Associated Infections (HAIs) = Transparency
As the New England Journal of Medicine states, “Elimination of health care-associated infections is a priority of the Department of Health and Human Services…continued improvements in patient safety depend on maintaining a comprehensive understanding of the epidemiology of health care–associated infections.”[1]
CDC’s HAI Prevalence Survey reported in 2011, that there were an estimated 722,000 HAIs in acute care hospitals, along with the additional point that 75,000 patients with HAIs died during their hospitalizations.[2] That is, a startling rateof 10% of patients infected had died due to an HAI in the United States- as recent as 2011.
Public reporting of HAI rates for all acute care hospitals soon became mandatory due to a need for increased patient safety. This was put into law through the Affordable Care Act during the fiscal year 2013; Sec. 3001 within Requirements: “Healthcare-associated infections, as measured by the prevention metrics and targets established in the HHS Action Plan to Prevent Healthcare-Associated Infections (or any successor plan) of the Department of Health and Human Services.”[3] This initiative started as a way to motivate hospitals to publicly report their rates of hospital-acquired infections.
An example of why standardization in requirements needed to occur; a California acute care hospitals study completed -just before mandatory reporting- found variability in many areas: For example, 70.1 percent of hospitals said that they were fully implementing evidence-based guidelines to fight infection by methicillin-resistant Staphylococcus aureus, but 22.8 percent of hospitals had not adopted any.[4] This large discrepancy in the ways hospitals were treating these infections is one reason why mandatory public reporting was necessary, for patient safety.
The next main reason behind mandatory public reporting was to provide financial incentives for the hospital. On August 1, 2014 the Centers for Medicaid & Medicare Services (CMS) issued a final rule that “that updates Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospitals Prospective Payment System (LTCH PPS) in Fiscal Year (FY) 2015.”[5] With this, Section 3008 established a “financial incentive program for IPPS hospitals to improve patient safety by applying a one percent payment reduction to hospitals that rank in the lowest performing quartile of all subsection (d) hospitals with respect to the occurrence of hospital-acquired conditions (HACs) that appear during an applicable hospital stay.”[6] Alongside that ruling, financial incentives concerning value-based care was also put into law through the Affordable Care Act; Section 3001 within Application, Appropriate Distribution: “The Secretary shall ensure that the application of the methodology developed under subparagraph (A) results in an appropriate distribution of value-based incentive payments under paragraph (6) among hospitals achieving different levels of hospital performance scores, with hospitals achieving the highest hospital performance scores receiving the largest value-based incentive payments”.[7] Due to both of these respective rulings, hospitals would be compensated, financially, to provide the best care for patients.
What is currently being done in the healthcare landscape, however, differs from this fair reimbursement- despite the law. There is a contradiction to the Centers for Medicaid & Medicaid Service’s (CMS) stated intention to reward hospitals providing high quality care at a lower cost. A GAO 17-551 Report findings, as recent as June 2017, stated, “Despite the program’s intention to reward hospitals that provide high-quality care at a lower cost, we found that some hospitals with low quality scores received bonuses because they had relatively high efficiency scores.”[8] Further, they reported, “Among hospitals that were missing one or more quality scores, the efficiency score had a greater effect on the total performance score because of the methodology used by CMS. This methodology compensated for the missing scores by increasing the weights of all of the non-missing scores. Consequently, hospitals with missing scores were more likely to receive bonuses than hospitals with complete scores.”[9]
Therefore, (1) Regulations to improve patient safety, along with, (2) Financial incentives for the hospitals were the two main reasons behind the public reporting mandate. The truth is in the facts as well, and as shown in a few examples below, positive changes occurred with HAI rates in the U.S. when they were reported transparently in the span of ’08 to ’14:[10]
· 50 percent decrease in CLABSI between 2008 and 2014
· 17 percent decrease in SSI related to the 10 select procedures tracked in previous reports
· 8 percent decrease in hospital-onset Clostridium difficile (C. difficile) infections between 2011 and 2014
· 13 percent decrease in hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia (bloodstream infections) between 2011 and 2014
· LTACHs: 9 percent decrease in CLABSI and an 11 percent decrease in CAUTI between 2013 and 2014
· IRFs: 14 percent decrease in CAUTI between 2013 and 2014
Ultimately, patients need transparency in Healthcare Organizations’ reporting of outcomes -in order to make- informed decisions. We have this opportunity in almost every other industry before purchasing a product and our personal health should be at the forefront. In seeing hospital’s actual outcomes, especially for Health care Associated Infections (HAIs), brings the power back to the people in determining where they should seek treatment. [This was also a noticed concern of the House and thus embedded with the Affordable Care Act; Section 3001 within Public Reporting: “The Secretary shall make information available to the public regarding the performance of individual hospitals under the Program.”[11] ]
“Transparency would at least help uninsured patients and all consumers of care know what they were going to be charged and the quality of the services they would receive.”- Dr. Regina Herzlinger, Harvard Business School[12]
[1] “Multistate Point-Prevalence Survey of Health Care–Associated Infections — NEJM.” New England Journal of Medicine, www.nejm.org/doi/full/10.1056/NEJMoa1306801#t=articleResults.
[2] “Multistate Point-Prevalence Survey of Health Care–Associated Infections — NEJM.” New England Journal of Medicine, www.nejm.org/doi/full/10.1056/NEJMoa1306801#t=articleResults.
[3] Senate and House of Representatives of the United States of America in Congress. ‘‘Patient Protection and Affordable Care Act.’’ 2010.
[4] Halpin, H A, et al. “Mandatory Public Reporting of Hospital-Acquired Infection Rates: a Report from California.” Health Affairs (Project Hope)., U.S. National Library of Medicine, Apr. 2011, www.ncbi.nlm.nih.gov/pubmed/21471494.
[5] “2014-08-04-2.” CMS.gov Centers for Medicare & Medicaid Services, 4 Aug. 2014, www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-08-04-2.html.
[6] “2014-08-04-2.” CMS.gov Centers for Medicare & Medicaid Services, 4 Aug. 2014, www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-08-04-2.html.
[7] Senate and House of Representatives of the United States of America in Congress. ‘‘Patient Protection and Affordable Care Act.’’ 2010.
[8] GAO. “HOSPITAL VALUE-BASED PURCHASING CMS Should Take Steps to Ensure Lower Quality Hospitals Do Not Qualify for Bonuses.” HOSPITAL VALUE-BASED PURCHASING CMS Should Take Steps to Ensure Lower Quality Hospitals Do Not Qualify for Bonuses, June 2017.
[9] GAO. “HOSPITAL VALUE-BASED PURCHASING CMS Should Take Steps to Ensure Lower Quality Hospitals Do Not Qualify for Bonuses.” HOSPITAL VALUE-BASED PURCHASING CMS Should Take Steps to Ensure Lower Quality Hospitals Do Not Qualify for Bonuses, June 2017.
[10] “Healthcare-Associated Infections.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 Mar. 2016, www.cdc.gov/hai/surveillance/progress-report/index.html.
[11] Senate and House of Representatives of the United States of America in Congress. ‘‘Patient Protection and Affordable Care Act.’’ 2010.
[12] Herzlinger, Regina. “Who Killed Health Care?” Who Killed Health Care? Harvard Business School.