Federal plan to reduce HAIs: public meetings

Let's switch back for a moment to MRSA and other infections in hospitals. An estimated 1.7 million healthcare-associated infections (HAIs) occur in the US each year. Approximately 99,000 of the infected die. Care for the infected costs the health care system $33 billion (yes, with a B) each year.

The US Department of Health and Human Services (parent agency of the CDC, USDA, Center for Medicare and Medicaid Services, etc.) in late June issued a draft of a National Action Plan to Prevent Healthcare-Associated Infections. The plan is here (.pdf, 116 pages). It calls for more research, changes in regulation of health care, more disclosure and significant simplification of the more than 1,200 actions for reducing HAIs that are currently recommended in government documents (yes, 1,200.)

HHS is taking the plan on the road: Before Labor Day, there will be public meetings to air the plan in Denver (tomorrow, July 25), Chicago (July 30) and Seattle (Aug. 27). If you are concerned at all about HAIs and government and health care industry response to them, these meetings would be a good place to be.

The HHS statement about the plan and the meetings, including contact information to sign up to attend, is here. Go, already.

Hospital gives patient MRSA. Should Medicare reimburse?

You have until June 13th to tell the government what you think. Details of how to comment at the end of this post because they are complicated.

Here's the back-story: Until recently, hospitals were reimbursed by the Center for Medicare and Medicaid Services (part of the US Department of Health and Human Services) whenever they provided care to Medicare or Medicaid patients, even if that care included a mistake, error or hospital-acquired infection. Thankfully, that is beginning to change. Last December, CMS proposed a rule change. In the agency's language:

Beginning October 1, 2008, Medicare will no longer pay hospitals at a higher rate for the increased costs of care that result when a patient is harmed by one of several conditions they didn’t have when they were first admitted to the hospital and that have been determined to be reasonably preventable by following generally accepted guidelines. (Quoted from this press release.)

In other words: Hospitals, you break it, you bought it.

These are the conditions for which, as of Oct. 1, 2008 (the first day of federal fiscal year 2009), Medicare will not reimburse:

• Object inadvertently left in after surgery
• Air embolism
• Blood incompatibility
• Catheter associated urinary tract infection
• Pressure ulcer (decubitus ulcer)
• Vascular catheter associated infection
• Surgical site infection - Mediastinitis (infection in the chest) after coronary artery bypass graft surgery
• Certain types of falls and trauma.

Note: MRSA is not on that list. But: At the same time, CMS proposed a second set of error-related conditions for which it will consider not-reimbursing, based on public comment. Some of those conditions are MRSA-related. The conditions are:

• Surgical site infections following certain elective procedures.
• Legionnaires’ disease (a type of pneumonia caused by a specific bacterium)
• Extreme blood sugar derangement
• Iatrogenic pneumothorax (collapse of the lung)
• Delirium
• Ventilator-associated pneumonia
• Deep vein thrombosis/Pulmonary Embolism (formation/movement of a blood clot)
• Staphylococcus aureus septicemia (bloodstream infection)
• Clostridium difficile associated disease (a bacterium that causes severe diarrhea and more serious intestinal conditions such as colitis)

CMS will decide whether or not to include any or all of those additional events by Aug. 1. The non-reimbursement would start at a later date that the first list.

This a complex topic and there is a long paper trail attached to it. Fact sheets are here. Definitions of the conditions, as accepted by CMS and the CDC, are here. The records of the Dec. 17. 2007 hearing in which this was discussed, including complete transcripts, is here.

Directions for how to comment electronically and by mail and hand-delivery (faxes are not accepted) are contained in this long Federal Register entry. Here is how to do it electronically:

• Go to http://www.regulations.gov
• Under "Comment or Submission," enter this file-code: CMS–1390–P
• Click on "Send a comment or submission" in the left-middle of the page.
• Fill out the form that comes up (you may have to page-down to see the full form).

HAIs: Congress weighs in

Today, the House of Representatives Committee on Oversight and Government Reform held a hearing on hospital-acquired infections, led by committee Chairman Henry Waxman (D-Calif.).

The witness list is here. A Government Accountability Office report that was presented during the hearing is here. Its title captures the committee's point of view: "Leadership Needed from HHS to Prioritize Prevention Practices and Improve Data on These Infections."

In opening the hearing, Waxman said:

[HHS] is not providing the necessary leadership. It has not identified for hospitals the most important infection control practices, and it is not coordinating the collection of data from hospitals in order to avoid duplication and unnecessary burden.
The failure of HHS leadership is particularly regrettable because these illnesses, deaths, and costs are preventable. Moreover, the preventive measures don’t require new technologies or large investments.

The witness list includes links to testimony, including some very powerful remarks delivered by HA-MRSA survivor Edward F. Lawton:

We possess the knowledge and capabilities to fight this enemy; we possess the educational and professional expertise to overcome and destroy it. The only question is whether we have the will to fulfill the mission!

(And BTW, apologies to loyal readers for disappearing for a week. I was speaking at the American Society of Journalists and Authors, and doing book-related research in New York. Back now.)