Medicare change sheds light on new infection precaution measures

Medicare change sheds light on new infection precaution measures

As part of Centers for Medicare and Medicaid (CMS) Rule-1553-P, effective October 1, 2008, Medicare will no longer pay for eight conditions that can be acquired by patients during hospital stays that could have been reasonably prevented by following evidence based guidelines. CMS hopes the change will improve accuracy in Medicare's payment under the acute care hospital inpatient prospective payment system (IPPS), while also creating incentives for the healthcare community to improve quality initiatives and patient care. With the CMS reimbursement rule going into effect, Oct. 1, 2008, healthcare facilities and workers are rapidly preparing for significant process and procedure shifts.

The Conditions

The initial eight conditions identified in CMS Rule-1553-P are: bed sores; objects left in a patient during surgery; in-hospital falls; blood incompatibility; air embolism; mediastinitis, which is an infection of the area between the lungs after heart bypass surgery; catheter-associated urinary tract infections; and central venous catheter-related bloodstream infections.

Additionally, on April 14, 2008 CMS proposed to supplement this list with an additional nine conditions, including surgical site infections following certain elective procedures; deep vein thrombosis or pulmonary embolism; Staphylococcus aureus septicemia or bloodstream infection; and, Clostridium difficile associated disease.

While the list includes some conditions and events that are rare, it also contains common and preventable nosocomial infections, which are often referred to as hospital-acquired infections (HAIs). The three HAIs included on the CMS list are central venous catheter-related bloodstream infections, catheter-associated urinary tract infections and mediastinitis. The Centers for Disease Control and Prevention (CDC) report that HAIs account for an estimated 1.7 million total infections and approximately 100,000 associated deaths each year in the U.S.

Fighting the Good Fight

While the CDC has set standards for cleaning and screening healthcare devices and surrounding insertion areas to curb the spread of infections, the healthcare community still faces a virulent opponent. As the CMS rule ties government reimbursements to hospital compliance with new preventative measures, hospital staffs are employing additional preventative practices. Some of the methods used to fight infection rates include embracing strict medical sanitation rules, proper hand-washing guidelines and innovative devices using the latest in medical device technology.

One of the more common HAIs is central venous catheter-related bloodstream infections or CRBSIs, which develop when bacteria enter patients' bloodstreams through the channel created by a central venous catheter. According to the CDC, CRBSIs account for 250,000 of the total 1.7 million U.S. HAIs reported annually and are the second-leading cause of death associated with HAIs, second only to pneumonia. Additional treatment costs for this nosocomial infection can be upwards of $30,000 per infection.

The healthcare community is embracing specific measures to lower CRBSI incidence rates, such as implementing the aforementioned strict hand-washing practices. Preparing the insertion area with chlorhexidine disinfectants and using full barrier sterile precautions when inserting devices, such as chest tubes and central venous catheters, also helps to reduce infection rates and alleviate the burden of the upcoming financial costs.

While sanitation and cleanliness are excellent methods to fight deadly CRBSIs, using a central venous catheter impregnated with antibiotics has proven to reduce the occurrence rates to nearly zero. The antibiotics minocycline and rifampin work to protect patients from bacterial organisms that can enter the bloodstream and cause an infection. The CDC guidelines acknowledge that catheters impregnated with these antimicrobial agents can lower the risk for and potentially decrease hospital costs associated with treating the infections.

A Different Healthcare System

While the new revision carries a number of challenges, it is helping to re-focus the healthcare industry on patient rights, safety and personal decision-making. Since being announced in August 2007, several states and numerous private insurance companies have embraced the rule and adopted similar policies. It is apparent that the healthcare industry is changing and evolving in reaction to public awareness to HAIs and preventable medical errors. Now, hospitals, physicians and patients will work more closely together to decrease HAIs.

The CMS Rule-1533-P will help to measure and improve patient care, educate providers on quality initiatives and should decrease the occurrence of preventable conditions acquired in hospitals, thereby reducing healthcare costs. More than ever, healthcare industry leaders must strive to eliminate barriers to the adoption of prevention practices in everyday patient care in order to save lives and eliminate infections and extra treatment costs.

Vice President and Chief Medical Science and Technology Officer at Cook Group in Bloomington, Indiana.


Changes in Clinical Diagnostics and Tracking Infectious Diseases (Video Medical And Professional 2020).

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