The Latest on Reducing Preventable Infections – Boston, Appleton, and DC


We had some local Boston news about hospitals reducing infection rates, including dangerous blood stream infections that result from central lines.

Several academic medical centers in Boston said the number of ICU patients contracting bloodstream infections had dropped by at least half in the past several years because of new procedures to keep intravenous lines and other tubes cleaner.

Regular readers of this blog will know about the successful “checklists” approach, simple procedures that (if followed) will prevent infections.

Hospitals also said they have reduced the number of patients on respirators who develop pneumonia – Beth Israel Deaconess Medical Center said so few patients now get this type of infection that the hospital was able to cancel plans to expand its ICU.

This is a major cost savings for the hospital that's run by this blogger.

Not only does preventing infections benefit the patients, it reduces healthcare costs for society — also saving money for the hospitals, since it's been shown that hospitals get reimbursed LESS than the true cost of treating the infection, so each infection is a net LOSS for the hospital.

Preventing infections means shorter Length of Stay for patients — better patient flow means fewer beds are required. Avoiding an ICU expansion could be a multi-million cost avoidance for a hospital like BIDMC.

A good question to ask of your local hospital(s) — have you implemented the checklists methodology to eliminate central line infections? If not, why?? What prevents faster spread of these proven methods?

So what's going on in the healthcare reform efforts (or “healthcare insurance reform,” really) in D.C.? This next article says that the issue of hospital acquired infections isn't being addressed well enough:

Getting The Bugs Out Of Health Reform – Kaiser Health News:

The author says that everyone in D.C. (in both parties) *talk* a good game about improving quality…

“But if you look closely at the legislation, you'll see that the proposals fall a bit short on that promise. The bill that passed the House of Representatives last month does have a section on reducing infections–and, smartly, it applies not only to hospitals but also to out-patient clinics, which are prone to the same problems. But the House bill requires only that hospitals and clinics report the incidence of disease. The bill doesn't attach financial rewards or penalties to the results.

The Senate bill Majority Leader Harry Reid just introduced is a bit better on that front. It establishes a monetary penalty designed to prod hospitals in the right direction: Medicare would reduce payments to hospitals whose infection rates put them in the worst quartile nationwide. But the penalty is tiny: Just one percent. And, unlike the House, the Senate chose not to extend the penalty to outpatient clinics.”

I guess public reporting is a good start. I could go either way on incentives or penalties, since people are pretty creative at gaming the system when there's money at stake.

Who stood in the way of doing more? Depending on who you ask, it was hospital lobbyists, career bureaucrats reluctant to tinker with Medicare, ideological opposition to aggressive regulation of medical care, or–most likely–some combination of all three. And, sadly, the same set of forces seem to have successfully undermined other, similarly inspired efforts at what's come to be known as “delivery reform.”

That's why I tend to call the current efforts “health insurance reform.” The “delivery reform” is coming from individual health systems (like ThedaCare) and collaborative efforts, like the IHI and the Healthcare Value Leaders Network.

If innovation is coming from outside of Washington, what can they do to incentivize these types of delivery reforms, or at least get out of the way? Read Dr. John Toussaint's public policy position paper to hear one leader's thoughts.

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