Getting Infected in the Hospital – Should Medicare Pay?

Most of us hope we and our loved ones won't end up in the hospital. In the event that we do, we have the hope that we will get through what we are in the hospital for and go home better off than we came to the hospital for.

The remarkable thing that many people don't know is that nearly 100,000 people per year get terrible infections in the hospital and die from them. One out of 20 patients get infections that they contracted in the hospital and some patients survive but have to be on medication for months or years, or even end up with long term or permanent illnesses or disabilities due to these infections.

What are some of the ways to avoid this situation? Several things have been suggested. A 2005 report showed that hospitals could charge the cost of health care-associated infections to third-party payers such as Medicare and Medicaid. Medicare has changed its rules in response to these concerns and will no longer reimburse hospitals for the excess costs associated with the care of patients who contract a hospital-associated infection. But now hospitals have no incentive to accurately report their infection levels. If Medicare were to provide hospitals with more resources for infection control, rather than just penalize them for caring for very sick patients who contract a hospital-associated infection, hospitals might perform better. Really?  Why not just perform better and be more careful now?

Last month, the U.S. Department of Health and Human Services released a plan urging hospitals and other health care facilities to adopt increased use of sterile techniques and follow strict protocols to prevent such infections. These include guidelines on the proper insertion of catheters and disinfection of ventilators, as well as practices that minimize risk of infection before, during and after surgery.

The University of Maryland Medical Center screens all patients at high risk for MRSA when they are admitted. Screening includes patients in intensive care units and those who have been in another health care facility during the past year. The tests are repeated during the hospital stay. Isolation precautions are instituted for those who test positive for MRSA. During the past year, the hospital has performed more than 33,000 MRSA screening tests. This aggressive action has slashed the hospital's rate of MRSA infection by more than 30 percent and has saved lives.

Patients with health care-associated infections move among hospitals, other health care facilities and nursing homes, and can spread the infections regionally. That means that a specific hospital does not necessarily receive all of the benefits from its infection control activities.

What's the solution? Infection control efforts should be a coordinated effort involving hospitals and  HHS and the Centers for Medicare and Medicaid Services. Hospitals could be provided with tools and incentives to work together so that they can coordinate infection-control measures. If regional coordination existed, infections wouldn't just be transferred from one place to the next.

Health care-associated drug-resistant infections are a complex problem. The overselling and overuse of antibiotics, as well as the lack of new antibiotics in the research pipeline, are driving the high rates of resistant infections. Timely prescribing of antibiotics can help reduce infections in hospitals, but we have to work to reduce overprescribing as well.  Hopefully government and hospitals will work together to come up with a policy that will bring this situation under control.

Filed under: General-Medicare

Tags: General-Medicare, Hospital Infections, medicaid