Infection prevention and control departments are about to become more important to a hospital’s financial well-being. Although many facilities have taken steps to reduce the number of hospital-acquired infections that plague the industry, the government is putting added financial pressure on hospitals to eliminate these costly problems.
Beginning in October 2008, the Centers for Medicare and Medicaid Services (CMS) ceased paying hospitals for treatments that become necessary due to three specific hospital-acquired infections (HAIs):
- Catheter-associated urinary tract infection
- Vascular catheter-associated infection
- Surgical site infection--mediastinitis after coronary artery bypass graft
The changes are making it necessary for hospital financial departments to work more closely with infection prevention and control professionals (ICPs), and that’s a move that could have benefits beyond the latest CMS rule, according to Kathy Warye, CEO of the Association for Professionals in Infection Control and Epidemiology (APIC).
How will the new CMS rule impact hospitals?
Warye: CFOs are going to be more interested in knowing what infections really cost an institution. A lot of institutions are finding that their reimbursements are not matching the outlay of expense in treating infections.
Beginning in October, CMS stopped paying to treat infections in three categories that are not present on admission. The ruling is likely to drive more testing to determine whether people have these infections when they come in. There will be an upfront cost associated with gaining that information. But understanding the risk of transmission will enable hospitals to prevent new costly infections. A thorough infection control risk assessment will help hospitals target their testing to use their scarce resources more wisely.
How does that relate to the supply chain and product selection?
Warye: ICPs can have an influence on the purchase of products, but in many cases, the ICPs don’t have as much influence as they could or should have in terms of being able to protect the patient. There are a number of new products--and even existing products--that have infection control or antimicrobial properties. Examples would be an antimicrobial-impregnated dressing or suture, which is at the low-end of the scale. At the higher end would be something like a silver-tipped, urinary tract catheter or an antibiotic-impregnated catheter.
Because these products tend to be more expensive, purchasing people often resist buying them. That’s where the ICP--if properly empowered by the executive staff of an institution--can influence the decisions on theses types of products. Most of these infection-fighting types of devices and supplies cost pennies on the dollar in comparison to the cost of the infection.
What other kind of products are available that are designed to reduce infections?
Warye: We’re seeing antimicrobial dressings that have been proven to reduce bioburden (or the number of microorganisms) on the skin. There is also a type of dressing designed to reduce bio-film. Bio-film is a sticky substance that is created naturally by the body after a surgical or other type of procedure. Bacteria and microorganisms attach themselves to the bio-film, so you can reduce the incidence of infection by reducing the bio-film.
However, if we can’t get people to look at the value of these innovations, then I don’t think we’re doing the right thing for patients, and we’re probably not doing the right thing for institutions in terms of making them as cost efficient as they can possibly be.
So, in the long run, it’s about quality and costs?
Warye: That’s right. There are a lot of arguments and studies that show better quality ultimately reduces costs. However, in infection control, I think there are these myths that infections are either revenue-neutral or there’s a net gain in reimbursement. However, a number of institutions have done very detailed economic analyses of their infection rates, and these facilities have discovered that the opposite is true--that is, these infections are costing the institutions large sums of money. It’s on the order of millions of dollars for the average institution. There hasn’t been a tremendous amount of economic analysis done industrywide on the cost of infections, but APIC has a white paper (Dispelling the Myths: The True Cost of Healthcare-Associated Infections) that highlights the findings from some individual institutions’ studies on the cost of infections.
Should an ICP be involved in the negotiating phase of a new product contract?
Warye: An ICP certainly should be part of the process in looking at how a new product would affect overall patient care from an infection and cost point of view. For example, if the institution is going to be buying urinary tract catheters, the ICP could make the case that buying a catheter with antimicrobial properties will cost more money upfront, but that these catheters are known to help prevent urinary tract infections. If the institution can prevent urinary tract infections because of the antimicrobial device, then the hospital will actually be saving money.
ICPs can also help differentiate between the products that really have infection-reducing properties and those that do not, based on epidemiological data and studies. An ICP should know which products are really going to have the greatest impact on better outcomes and reduced costs. So, ideally, an ICP needs to be brought in earlier in the process and be able to influence purchasing decisions.
Are manufacturers providing information on the infection-reducing abilities of their products?
Warye: Certainly, and I think the vast majority of the suppliers understand that if they’re going to get any traction, they’re going to need to come in with sound scientific data. Often they present that type of data to the ICP. But the ICP can have tremendous difficulty getting the attention from the product review committees and materials and supply people to change their purchasing decisions and patterns. That’s one of the reasons it takes so long for new innovations and products to really get into use, because you’ve got these silos and you’ve got these barriers.
Most medical device and supply manufacturers spend tremendous sums of money doing scientific studies to prove whether their products really do reduce the risk or rate of infection. They are increasingly incorporating an economic analysis into this process. It’s the ICP and the epidemiologists that need to look at that data, which could be very informative in the process of deciding what products are going to be selected. But, once again, it all comes back to, ‘Do institutions know what their infections cost them?’ Until you know what your infections cost, you don’t know if that incremental charge is a positive or a negative for you.
APIC offers educational materials on reducing infections at the association’s website, www.apic.org.
For more information on products that reduce HAIs, see the following article:
Crosby, C., “Products that help reduce HAIs,” Materials Management in Health Care, September 2008 issue.