The Price of Hospital Acquired Infections
Posted by Pauline Heidemann on Fri, Feb 03, 2012 @ 06:04 AM
Hospital acquired infections (HAIs) are the 4th leading cause of death in the United States. Nearly one in every 20 patients acquires an HAI following hospitalization, resulting in 100,000 deaths per year. HAIs kill more people than prostate and breast cancer combined, and they pose a far more serious mortality risk than AIDS and automobile accidents.
The mortality numbers are frightening enough, but they are only part of the equation. HAI survivors are likely to experience longer hospital stays, with an average of 22 days, compared to an average five-day stay. Hospital readmission rates are almost 30% for patients with HAIs, compared to just 6% for patients without this complication. Many patients who recover from HAIs continue to experience health problems; many struggle with daily pain, have difficulty returning to work or leisure activities, and most are saddled with additional medical costs.
And then there is the financial toll. Total costs from HAIs are estimated at between $35 and $88 billion annually. According to the Centers for Medicare and Medicaid (CMS), each HAI costs a hospital $23,228, and CMS is currently spending $17.4 billion annually for readmissions associated with HAIs. Legal costs are also a factor affecting health care. Many HAIs are the subject of litigation, and it is estimated that one of every six claims against health care facilities is related to HAIs and HACs (health acquired conditions), accounting for 12.2% of legal liability costs insured by health care facilities.
Despite these alarming numbers, the incidence of HAIs has decreased only minimally since the 1990s, with 1.9 million HAIs estimated in 1995 compared to 1.7 million in 2002. The death rate has not declined at all over the past two decades, with a fairly consistent 6% probability of death.
Until recently, hospitals had little incentive to focus on preventing HAIs, but all that is changing dramatically as the federal government is directly linking reimbursement to the quality of care provided, with a special focus on HAIs and HACs. CMS has eliminated Medicare payments for costs due to several HACs, including falls, retained foreign objects, air embolisms, and four of the most common HAIs, and is expected to eventually reduce payments for additional HAIs and readmissions associated with HAIs. In addition, hospitals will be penalized by Medicare if their rate of HAIs and HACs puts them in the bottom performing quartile. Starting in 2015, hospitals that reach this level will lose one percent of their overall Medicare reimbursement. And, while CMS is actively and aggressively implementing reimbursement policies linked to performance, private payers are expected to follow suit as well.
HAIs are essentially preventable, and new protocols aimed at arresting their occurrence have shown remarkable success. Something as simple as a checklist has proven to be an effective strategy. Dr. Pronovost at Brigham and Women’s Hospital in Boston developed a checklist of five basic steps for physicians to follow at when placing a central-line catheter: wash their hands; clean the patient’s skin; wear a mask, hat, gown and gloves; put a sterile drape over the patient; and avoid placing the catheter the groin where infection rates are high. After a month of observation, in more than a third of patients, the physicians skipped at least one step. Checklists were implemented to eliminate these omissions.
After adopting an infection prevention checklist in the state of Michigan, the rate of blood stream infection dropped by 63% in just three months. The infection rates fell so low that its average ICU outperformed 90% of ICUs nationwide. Electronic systems are also being implemented with great success as a way to prevent HAIs.
Partnership for Patients, an initiative funded by the Affordable Care Act, has instituted a campaign to reduce the number of harmful preventable conditions by 2013 by 40%. Achieving this goal would mean approximately 1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years. The initiative also aims to achieve a 20% reduction in hospital readmissions by 2013. In addition to saving lives and preventing injuries, the cost savings could potentially be $35 billion, including up to $10 billion in Medicare savings over the next three years. This program also could reduce costs to Medicare by about $50 billion.
Although these statistics are frightening and grim, the good news is that hospitals are now focusing on the prevention of HAIs. Dr. Atul Gawande, a surgeon at Brigham and Women’s Hospital, has described HAIs as “the easiest 100,000 lives we can save.” There is no need to search for a cure or hope for a miracle. By putting systems of checklists, protocols, training, and technology in place that enable health care providers to solve this costly and preventable problem, hospitals can move beyond infection control to infection prevention.