Catheter Associated Infection- A never event Part I

Unless you haven't been at a staff meeting recently, you are probably well aware of the term "never event". A term used to describe a set of clinical outcomes that are designated as being avoidable hospital events. Pertinent to the vascular device community is the inclusion of vascular catheter infections. Vascular catheters and their respective uses are quite familiar to interventional radiologists, vascular surgeons, interventional nephrologists and cardiologists.

In our market economy, identified problems frequently present an opportunity for innovation. Innovation in catheter design will no doubt address some of these infection control dilemmas. Additionally, it will be interesting to follow the process of monitoring catheter infections in non hospital based settings. Today's post is an informative introduction of the background to the DRA of 2005. We'll follow up with a post on specific technology

The Issue

On February 8, 2006, President Bush signed the Deficit Reduction Act of 2005 (Pub. L. 109-171) (DRA) which contained language[1] creating a system for quality adjustment of Medicare payments for inpatient hospital services. The law required the Secretary of Health and Human Services (HHS) to identify at least two hospital-acquired conditions which could have reasonably been avoided through the application of evidence based guidelines and would be subject to the adjustment in payment.

Background

 

The rate of growth in health care costs has made it necessary for payers of health care services to examine every avenue available to conserve health care dollars. According to the Congressional Budget Office (CBO), without any changes to federal law, total spending on health care will rise from 16 percent of the gross domestic product (GDP) in 2007 to 25 percent in 2025 and 49 percent in 2082, and net federal spending on Medicare and Medicaid will rise from four percent of the GDP to almost 20 percent over the same period. CBO sites inefficiency in the health care system as a principle variable contributing to the increased cost. They support this notion through an examination of the variation in health care cost across the country yet noting that the quality in health care is less variable.

The Institute of Medicine has estimated that medical errors cost $17 billion to $29 billion per year with most of the cost being shifted to outside payers such as Medicare. Research conducted by the Harvard School of Public Health[2] in 2006 found after examination of 14,732 discharge records from 24 hospitals in Colorado and Utah, the average cost per injury was $58,766 for all adverse events and $113,280 for negligent injury. They also concluded that 78 percent of the costs associated with all injuries were externalized to outside payers and 70 percent of costs associated with negligent injuries.

Federal Actions

Taking these factors into consideration, the DRA required CMS to select at least two hospital-acquired conditions that would be subject to a quality payment adjustment. CMS consulted with the Centers for Disease Control and Prevention (CDC) to identify the conditions proposed for reduced payment in FY 2009 and additional conditions that would be considered for reduced payment in subsequent years. The conditions were selected from a list of "never events" or conditions which had been identified by the National Quality Forum[3] in 2002. "Never events" are serious reportable events, which should never have happened and could have been prevented[4]. Specific criteria for selection of the conditions were provided as follows:

1. The condition must be associated with a high cost of treatment or high occurrence rates within hospital settings.
2. The condition results in higher payment to the facility when submitted as a secondary diagnosis.
3. The condition can reasonably be prevented by adoption and implementation of evidence-based guidelines.

Selected Conditions The first eight conditions, which were selected last year because they greatly complicate the treatment of the illness or injury that caused the hospitalization, resulting in higher payments to the hospital for the patient's care by both Medicare and the patient were: Object inadvertently left in after surgery Air embolism Blood incompatibility Catheter associated urinary tract infection Pressure ulcer (decubitus ulcer) Vascular catheter associated infection Surgical site infection-Mediastinitis (infection in the chest) after coronary artery bypass graft surgery Certain types of falls and traumas 2008 Additions Surgical site infections following certain elective procedures, including certain orthopedic surgeries, and bariatric surgery for obesity Certain manifestations of poor control of blood sugar levels Deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures.

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