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Today’s CMS Rule: A Major Step for HAI Reporting – Part 1

Posted on by CDC's Safe Healthcare Blog
Michael Bell, MD
Michael Bell, MD

Mike Bell, MD
Deputy Director,
Division of Healthcare Quality Promotion, CDC

It’s a new day in our efforts to eliminate healthcare-associated infections (HAIs). A rule released today by the Centers for Medicare & Medicaid Services (CMS) lays out HAI reporting requirements for Medicare eligible hospitals that participate in CMS’ pay-for-reporting program. More than 3,500 hospitals will soon use CDC’s National Healthcare Safety Network (NHSN) to report central line-associated bloodstream infection (CLABSI) and surgical site infection (SSI) data to CMS. In turn, the agency will post the information on the HHS publicly accessible Hospital Compare Web site.

The release from CMS today is yet another sign that HAIs are recognized as a significant measure of healthcare quality. It is encouraging to see CMS build upon its work in preventing healthcare-acquired conditions, including HAIs.

So, what does this mean in practice?

For healthcare facilities – it connects financial incentives to HAI reporting. In other words, facilities that report will be recognized and rewarded for their efforts. We expect that this change will fuel existing momentum toward HAI prevention and elimination programs already happening within healthcare facilities across the country.

For patients – it is an excellent way to see how their hospital is doing on several quality of care issues, including preventing infections. It will be the first time patients from all states can view the infection data from their local hospitals. This information can serve as a discussion point between patients and their healthcare providers.

For our healthcare system – it increases our accountability and transparency. Data on HAIs can drive our prevention initiatives. When we know where infections are occurring, we can work to prevent them and protect patients.

To implement this rule, we will start with a phased approach. In 2011, CLABSI data will be reported, and we are starting with the most vulnerable patients – those in intensive care units and neonatal intensive care units. In 2012, data from surgical site infections (SSIs) will be reported. We expect to expand further in coming years.

It will be critical for facilities to take a team approach. Hospitals will need to rely strongly on their infection preventionists and healthcare epidemiologists, as well as all practicing clinicians. In our next several blog posts, you will hear from infection preventionists, healthcare epidemiologists, clinicians, and consumers on their perspectives of this new rule.

In the meantime, tell us your thoughts.

Posted on by CDC's Safe Healthcare Blog

12 comments on “Today’s CMS Rule: A Major Step for HAI Reporting – Part 1”

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    Wow you “A TEAM” To help them make intelligent choices about where to seek care, hospital customers need to be informed about the antibiotic-resistant pathogens — and the infection rates associated with them — in area hospitals and clinics.

    Thank-you in advance! This is one of the best blogs Ive ever read. I was not expecting that I’d get so much out of reading your write up!

    Simply just needed to say I truly enjoy your work on this blog and the quality posts you make. These type of posting are what keeps me going through the day time.

    Normalizing per 1000 days (or any other interval) implies that the probability is independent of the duration that a catheter is in place or a patient is intubated, which seems incorrect. Presumably, the probability of a CLABSI or a VAP is a function of time as the probability of say VAP for patients intubated for a few hours is certainly less than if intubated for days. If this were not true minimizing duration of for example, intubation or urinary catheterization would not be important.

    I am pleased to see that HAI’s are getting more national attention. I am disappointed as a clinician, that it has come to payers, such as CMS, to order reporting of HAI metrics and tie reimbursement into the process. Many states on their own, have required state reporting of HAIs metrics, for years and many hospitals have been tracking HAIs internally and implementing processes and procedures for over 25 years because they were concerned about the Quality of Care being delivered to patients. We developed a Patient Safety Video, about 10 years ago, which addressed patient safety issues, as well as hand washing of clinicians and family members, to prevent the spread of infection. We addressed central line insertion issues, surgical wound infections, anti-infective resistance/Stewarship, and treatments in our homecare/home infusion setting, etc. These are not new topics. I believe that the Accountable Care Organizaion (ACO) model, will tighten the Continuum of Care tracking of HAIs and lead to more improvement in patient care in this area.

    I believe in the consumers right to valid information when making a choice of healthcare facility.

    My concern is the validity of the data for comparison purposes. The accuracy of the data is dependant on the method of identifying potential HAI’s, the knowledge and skill of the preventionist or designee and of course the time allowed for the surveillance project.

    The type of healthcare facility reporting the data may also impact the accuracy. An example is reporting of SSI’s. A healthcare system that has healthcare records shared by the hospital and medical clinics allows for more realistic identification of a SSI diagnosed ipost operatively in the clinic setting.

    The ultimate question of course is just how accurate leadership allows the staff to be in identification and reporting when there is a dirct impact on how the faciltiy is perceived in their healthcare system and in the community.

    Where do we go from here and how committed to improved patient care will we be as things become more transparent?

    As an infection preventionist I welcome the attention that health care associated infection has been getting. I’m somewhat concerned that reporting requirements will require more resources than many hospitals are willing to devote to infection prevention and control. Unless reporting makes use of electronic data (administrative data which has shown to be inaccurate) infection preventionists will be forced to focus on the reporting aspect rather than the prevention aspect.

    There should be national standard for infection preventionist staffing at the minimum based on bed size.

    This CDC program, while a welcome effort, will under-report rates of “hospital associated infection.” Hospital services users (patients is such a hopelessly patronizing concept) will still not be fully informed about an institution’s nosocomial infection rate. Customers will not be informed, for example, of MRSA infection rates. Nothing inspires more defensive and obfuscating responses from hospital staff than the simple question, “What is your nosocomial infection rate?”

    To help them make intelligent choices about where to seek care, hospital customers need to be informed about the antibiotic-resistant pathogens — and the infection rates associated with them — in area hospitals and clinics.

    Abuse and incompetence aside, hospital associated infection may be the Achilles heel of medicine.

    Although I fully subscribe to minimizing and reproting HAI, I am concerned about the metric used for catheters and VAP. Specifically, normalizing per 1000 days (or any other interval) implies that the probability is independent of the duration that a catheter is in place or a patient is intubated, which seems incorrect. Presumably, the probability of a CLABSI or a VAP is a function of time as the probability of say VAP for patients intubated for a few hours is certainly less than if intubated for days. If this were not true minimizing duration of for example, intubation or urinary catheterization would not be important.

    Assuming the daily probability of the remaining infection-free is constant and independent of the preceding day which was infection-free, isn’t the probability of remaining infection-free for N days equal to the probability of being infection-free each day raised to the Nth power. If I am correct, infections should be normalized to the duration at risk for each patient rather than per total patient days at risk and the latter would be a misleading statistic.

    Dr. Bell,

    I am so excited about the changes that are occurring in healthcare and the power that has been granted to those receiving care. Information such as this, is very important to the public. I hope that society and the “business side” of healthcare pay very close attention, because now they will really have to strive to achieve and perform excellence and not just use it as a slogan in hope of gaining a larger consumer base. I am a 29-year-old Registered Nurse from Wallace, SC. I advocate not only for patients, but their families as well. It does my heart good to see the positive changes to whereas, the people now have a voice. It also ensures and improves the chances of great healthcare for all. I am realistic and I know that problems arise. I wish there was more that I could do with such situations. I would also like state that appreciate the “hands-on” approach of President Obama. I actually watched a video, where he personally was explaining to the public how to use a new website to choose better healthcare for themselves. Amazing. The things that we could do if we all worked together and for the better of all people. By chance, Doctor…do you know of any actions that healthcare systems are taking towards the “GO Green” movement? I am very interested. I have some ideas.

    God Bless,

    Natasha A. Leak, RN

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