As many as 2 million already ailing Americans will acquire an infection while hospitalized, with 90,000 of them dying as a result. Hospital acquired infections (HAIs) will add to the cost of an individual patient’s care anywhere from $1,000 to $50,000, while they will impose a direct hit of anywhere from $28 billion to $45 billion for institutions’ bottom lines. If HAIs seem like a problem for U.S. health care, they certainly are — why is Uncle Sam suddenly proposing to retreat on regulations to crack down on them?
USA Today reported that patient safety advocates are sounding alarms about new rules, set to take effect in November, from the Centers for Medicare and Medicaid Services (CMS). The agency, which wields great sway over hospitals because so many patients’ medical costs are covered by Medicaid and Medicare, plans to slash the information it provides to the public on HAIs involving: “super bugs” like MRSA (methicillin-resistant Staphylococcus aureus), post-operative sepsis and surgical site infections, as well as accidents and injuries ranging from bedsores to respiratory failure after surgery.
CMS also would stop informing the public about “never events,” medical mistakes committed in hospitals and considered so ghastly that they “never” are supposed to occur.
The agency, instead, plans to put in place a new program that targets poor performing hospitals, institutions that rack up scores on various measures putting them in the bottom 25 percent. They would be penalized with cuts in their Medicaid reimbursement unless they clean up their act.
Patient safety advocates have blasted the CMS changes. Leapfrog, an influential group made up of employers and other large purchasers of medical services and that says it seeks to improve the quality and safety of American health care, has issued a call to action, asking concerned individuals and organizations to monitor the CMS plans and to contest them in letters and calls to the agency and lawmakers.
Leah Binder, Leapfrog’s CEO, told USA Today that the CMS proposals are unacceptable, and, though they apparently bubbled up in the agency and were not driven by powerful hospitals lobbying, “I’d never see them having the gall to be that outrageous. But I’m sure they are not going to complain.”
Although the bureaucrats have blathered about the burden and costs that they see HAI reporting imposing on hospitals and the health care system, it might be more apt to ask: What the heck are they thinking and who do they think they’re supposed to be serving — sick patients, staggered more by infections they get in places that are supposed to make them well, or hospitals, doctors, and insurers reaping in profits that seem to rise by the second?
In my practice, I see the harms that patients suffer while seeking medical services, including the costly, discomforting financial and health consequences of complications due to HAIs. As in many matters, sunshine — legally compelled disclosure about problems that hospitals and other institutions try to keep in the dark — has acted as a disinfectant, benefiting patients, their safety, and pocketbooks by helping all too slowly to push caregivers to reduce HAIs. It doesn’t make sense of watchdogs to ease up as institutions are starting to attack a debilitating and lethal problem.
If anything, we need officials to step up their oversight. HAIs are just a part of the giant problem of medical errors. A Johns Hopkins surgeon has published research showing they kill an estimated 250,000 Americans annually, making medical errors the third leading cause of death in the country, outpaced only by heart disease and cancer and ahead of killers like respiratory disease, accidents, stroke and Alzheimer’s. We can’t adequately address and suitably fix this problem unless we know its scope, scale, and detail.
For patients, any reduction in transparency about the quality and safety of their care should be robustly justified, not handed down in complicated, arcane rule-making agency fiat. CMS’ prospective roll-back in its HAI disclosure also comes atop the agency’s distressing stalls in releasing its latest data on so-called hospital star ratings. After years of discussion and tussling with hospitals, the agency had adopted a system of synthesizing a load of complex, detailed information on hospitals’ quality and safety records and rolling it up into a metric that patients could comprehend and use — a web site that featured that data and stars awarded to hospitals based on their performance.
Hospitals belly-ached about the data, how it was weighted, and their rankings. They don’t say it loudly, but, of course, these ratings can sway patients and affect how much many millions or tens of millions of dollars that hospitals bring in annually. So, hospitals have done all in their power to derail the ratings. But, hey, that’s what they’re supposed to do, right, let markets help boost safe, effective, affordable, and accessible medical care? C’mon, CMS, get your heads on straight, for patient’s sake