National Implications
On a national scale, hospitalists have helped compile other educational packets and toolkits to address the spectrum of HAIs, from ventilator-associated pneumonia to methicillin-resistant Staphylococcus aureus (MRSA).
More help may be forthcoming through the American Hospital Association’s Health Research and Education Trust. The broad-based effort, funded by the federal Agency for Healthcare Research and Quality (AHRQ), is partnering with SHM and other professional societies to implement small HAI-reduction successes on ever-wider scales. The University of Michigan’s Dr. Saint, for example, is a key partner in the trust’s national initiative to reduce CAUTI rates and improve patient safety.
How do you take what will work in one hospital, given its culture and microculture, and then apply it to hospitals across the state, or even across the country?.
—Sanjay Saint, MD, MPH, FHM, professor of internal medicine, University of Michigan, Ann Arbor
Medicare has rolled out its own collection of carrots and sticks to address the problem. The largest carrot, the public-private Partnership for Patients, has joined with SHM, other professional societies, and roughly 3,000 hospitals, so far, and set the ambitious goal of reducing hospital-acquired conditions by 40% by the end of 2013, compared with 2010 tallies. Although applauding the program’s overall goals, physicians, including Dr. Maynard, are taking a wait-and-see attitude, pointing out that many of the details have yet to be ironed out.
Among the sticks, Medicare has begun withholding reimbursement payments for such HAIs as CLABSIs and CAUTIs. Due to intricacies in how hospitals bill under the current DRG system, Dr. Kavanagh says Medicare’s nonpayment policy has recouped relatively little money from its first full year: about $18.8 million in all.
“The policies that cover public reporting, however, do have much more of an impact,” he says. “It’s more of a perceptual sting. Believe me, it is more concerning to have data of bad results that are available to the public than to be penalized by the current financial incentives.”
Other financial policies could carry considerably more weight. The threat of nonpayment for hospital readmissions, Dr. Maynard says, “totally changed the game” by intensifying efforts to reduce those rates, addressing contributing factors such as HAIs in the process. In combination, he says, public accountability through mandated reporting plus financial penalties could prove more powerful than either tactic alone.
Regardless of how federal policy plays out, experts say a new era of accountability and transparency is on its way. As the champions of positive change, hospitalists have a distinct opportunity to help lead the way and bring about a culture that consistently embraces effective interventions—before things get really ugly.
Bryn Nelson is a freelance medical writer based in Seattle.
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