22 August 2008

Not-reimbursing hospitals for MRSA: The reaction

You'll remember that early in the summer we talked about the proposal by the Center for Medicare and Medicaid Services to cease reimbursing hospitals for the additional care of a patient that is required when a hospital gives a patient a nosocomial infection. CMS has been debating whether to include several types of hospital-acquired infection in the 2009 iteration of its "never event" no-reimbursement list. (CMS has not announced its final choices.)

Healthcare's reaction has been, hmmm, not positive. At The New Health Dialogue, Joanne Kenen captures the reactions, many of which run along the lines of "infections are inevitable because patients are so sick." But she's also found a marvelous (and appalling?) argument that goes, more or less, "Preventing infections will be more costly, not less, because hospitals will introduce additional procedures to protect themselves."

This recalls the intriguing and dismaying suggestion in JAMA a few weeks ago that "search and destroy" active surveillance is driven less by wanting to halt in-hospital transmission and more by hospitals wanting to build a case that patients brought the infection with them.


Maryn McKenna said...
This comment has been removed by the author.
Anonymous said...

The changes to the Medicare reimbursement policy on hospital acquired infections is an interesting topic.

A similar article can be found here: www.mrsasuperbug.info/blog/process-technology-better-patient-care/

Jody Lanard M.D. said...

Re: the notion that active surveillance may be "driven less by wanting to halt in-hospital transmission and more by hospitals wanting to build a case that patients brought the infection with them."

Haven't read the JAMA article, and I ask the following question with an open mind:

Does the motivation matter much if it leads to reduced hospital spread of MRSA, and fewer patients getting seriously ill from the bugs they brought in with them?

My husband exercises to look good, not to take care of his cardiovascular system -- but it still helps his health.

Maryn McKenna said...

Very practical question. It seems unlikely that hospitals are going to not work to control transmission regardless of the source. At the same time, it feels ... unseemly? ... for them to find a way to game surveillance so that their reimbursements will not be reduced.

Thought experiment: If hospitals can use AST to pin responsibility for in-hospital transmission on colonized patients, will they significantly increase what they charge those patients, to pay for care and cleanup of the nosocomial cases those patients might cause?

Alternatively, if transmission happens in the hospital, should we consider it the hospital's responsibility because it represents an infection-control failure regardless of the organism's source?