Monday, September 02, 2013

Reducing hospital acquired infections to reduce costs

What's one of the best ways to reduce health care costs?  Stop hospital acquired infections.

JAMA posts an article outlining the costs of the most common such infections.  An excerpt:

On a per-case basis, central line–associated bloodstream infections were found to be the most costly HAIs at $45,814, followed by ventilator-associated pneumonia at $40,144, surgical site infections at $20,785, Clostridium difficile infection at $11,285, and catheter-associated urinary tract infections at $896. The total annual costs for the 5 major infections were $9.8 billion, with surgical site infections contributing the most to overall costs (33.7% of the total), followed by ventilator-associated pneumonia (31.6%), central line–associated bloodstream infections (18.9%), C difficile infections (15.4%), and catheter-associated urinary tract infections (<1%).

There is only one thing wrong about the article, the policy conclusion:

As hospitals realize savings from prevention of these complications under payment reforms, they may be more likely to invest in such strategies.

Here's where they are wrong on this point.  You do not have to institute so-called "payment reform" to incent hospitals to eliminate infections.  Even under a fee-for-service rate design regime, hospitals that engage in work flow redesign to eliminate infections find improvements in efficiency, reduction in length of stay, and higher utilization of high fixed cost facilities.  While there might be some revenue loss from a reduction in complications, that is more than offset by these other considerations.  There is a strong business case to be made regardless of rate design.  Many of the most dramatic improvements in elimination of hospital acquired infections have occurred in hospitals during a fee-for-service regime.


Anonymous said...

With those kind of dollar numbers cited, doesn't it seem to indicate that most hospital administrators must be head-bangingly stupid not to have been doing this all along? I will never understand what numbers they are looking at to make the decisions they make. (Not that dollar numbers should drive every decision anyway, but they do.)


Anonymous said...

Mr. Levy, how do I contact you without it being posted on the web? This iis in regards to controlling HAI. Thank you, Tom

Paul Levy said...

Please leave a comment with your email, and I will not post it.