Medicare Encouraging Patient Safety through Financial Disincentives -- by Lisa Hayden Espenschade

On October 1, 2008, Medicare placed new financial responsibilities on hospitals for certain “reasonably preventable” hospital acquired conditions.  In addition to Medicare’s new policy, covered here in more detail previously, private insurers are following suit.

 

Catheter insertion is associated with two conditions on the list: vascular and urinary tract infections. Medicare is also targeting surgical site infections after coronary artery bypass and some other orthopedic and bariatric procedures.

 

These three types of infections accounted for 42,096 cases in fiscal year 2007, according to the Centers for Medicare and Medicaid Services. Vascular catheter-associated infections are the worst offender on Medicare’s list--affecting 29,536 patients in 2007. Bladder catheterization is linked to another 12,185 infections.

 

Economic incentives, such as no longer elevating payments to cover the costs of preventable complications are likely to motivate improvement, but to improve, hospitals need effective systems designed to prevent the medical errors in the first place.

 

Many prevention principles – particularly hand hygiene – apply to both these types of catheter-related bloodstream infection (CR-BSI).  This is where Hospital Video Auditing (HVA) can help:  it gives 24/7/365 monitoring for adherence to safety practices and protocols and encourages health care workers to both improve and sustain their performance. 

 

Previous posts on CR-BSIs include:

Hygiene. A study at Huguley Memorial Medical Center in Fort Worth, TX, looked at simple measures for limiting infection: practicing hand hygiene, avoiding femoral lines because of proximity to the groin, using gloves and other physical barriers, and monitoring the appearance of lines.

Checklists. Atul Gawande’s December 10, 2007, article in The New Yorker detailed infection prevention research from Peter Pronovost, a critical-care specialist at Johns Hopkins Hospital. Pronovost found providers often skipped crucial steps during line insertion. Our post excerpting Gawande’s article includes information on hospital culture and successes using checklists.

Studies, Statistics & Safety. Robin Walters, RN, BSN, notes studies about costs of CR-BSIs plus strategies and guidelines for prevention. Among them: the Central Line Bundle from the Institute for Healthcare Improvement and participation in infection prevention collaboratives like the 5 Million Lives Campaign and the National Healthcare Safety Network.

Lisa Hayden Espenschade is a freelance writer based in Scarborough Maine who has written on genomics, gene therapy, stem cells, and other drug discovery topics, as well as other biotechnology issues.

 

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