Consumers, hospital critics welcome CMS changes

Consumers Union says add MRSA to list

While praiseworthy, a Centers for Medicare & Medicaid Services (CMS) decision to halt payment on additional costs generated by certain infections should have gone further and included methicillin-resistant Staphylococcus aureus (MRSA), a consumer advocacy group argues.

The Consumers Union — publishers of Consumer Reports — said CMS data show that more than 95,000 Medicare patients had MRSA infections in 2005, running up hospital charges of almost $3 billion. Yet MRSA was not selected for nonpayment because of coding issues and because CMS does not believe there is a consensus among public health experts that MRSA infection is preventable, the consumer group noted. "CMS needs to take strong action to curb the spread of this powerful superbug," says Lisa McGiffert, director of the union's Stop Hospital Infections campaign. "Many hospitals do not share the attitude that MRSA infections cannot be prevented and CMS should be on the front lines with them fighting this deadly and costly problem."

The announcement that Medicare will no longer pay hospitals for "conditions that could reasonably have been prevented" is a loud and, many would say, long-overdue wake-up call for American hospitals, argues Lucian Leape, MD, a member of the Institute of Medicine committee that issued the landmark report To Err is Human.

"Officials are reflecting the rising indignation of the public at the high rate of harm they experience when hospitalized," he wrote in the Boston Globe.1 "People have long been baffled by — and unforgiving of — . . . sponges leftin patients, surgery on the wrong site, mismatched transfusions, etc. But they also don't think they should fall or get infections or pressure ulcers when they go into a hospital, and they think hospitals have been far too blasé about their responsibilities to prevent harm."

Since the IOM committee issued the report eight years ago, patient safety leaders have been calling on hospitals to get serious about safety, to make a commitment to eliminating preventable injuries, and to implement known safe practices that will prevent them, Leape notes. "Some have," he notes. "Most have not. It was as if the safety folks were speaking a foreign language. Now the hospitals are being spoken to by people with authority and in a language they understand: the language of money."

Hospitals have had the opportunity for some time to help their patients and save money by implementing a number of proven safe practices — bar coding of medications, computerized ordering, prevention of bloodstream- and ventilator-associated infections, to name a few — and most have ducked it, he charges. The business case for safety has been well established. "Now it is the payers, not the hospitals, who will save the money — and, if we're lucky, the public — in the unlikely event that savings get passed on in reduced premiums," he says.

Evidence is increasing that many injuries and infections are preventable, Leape noted, citing the dramatic reductions in hospital-acquired bloodstream infections and pneumonia in the Keystone Project in Michigan intensive care units.2

"Those were in the ICUs, not all patients," says Tammy Lundstrom, MD, JD, who spoke on behalf of the Association for Professionals in Infection Control and Epidemiology. "The other thing is that even though they were reduced dramatically they were not eliminated. They were reduced to zero for some months at a time, but every institution continued to have infections. So unlike objects left in during surgery — which I think we all agree should be prevented 100% of time — the science really isn't there [on preventing bloodstream infections beyond the ICU]. All of the work was done in ICUs, which is a much different environment than the floors."

References

  1. Leape L. Why pay for mistakes? Boston Globe Aug. 23, 2007.
  2. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006; 355:2,725-2,732.