Surgery News - November 2008 - (Page 10)

NEWS SURGERY NEWS • N O V E M B E R 2 0 0 8 CMS Rule Imposes Infection Documentation Challenge BY MIRIAM E. TUCKER Else vier Global Medical Ne ws A R L I N G T O N , VA . — Ensuring “accurate and appropriate physician documentation on the patient record” is considered the area in greatest need of urgent attention, according to a survey of 934 hospital infection preventionists. As of Oct. 1, Medicare will no longer pay for care associated with hospital-acquired infections including surgical site infections, catheter-associated urinary tract infections, and vascular catheter–associated infections. Compliance requires documentation of whether the condition was present on admission (POA). The survey was presented at a conference sponsored by the Association for Professionals in Infection Control and Epidemiology (APIC) and the Premier Healthcare Alliance. Of the survey respondents, 90% work in infection prevention/control, 2% work in quality/performance improvement, and the rest serve as patient safety experts, as administrators, or in another capacity. A fourth of the respondents (25%) work in facilities with 100 beds or fewer, 31% work in institutions with 101-250 beds, and 16% work in facilities with 500 or more beds. Most (55%) are located in 1 of the 27 states that currently mandate reporting of health care–acquired infections (HAIs). Asked which listed activity they believe “needs the most attention to optimize your organization’s readiness” for the new payment regulations from the Centers for Medicare and Medicaid Services, 52% responded “accurate/appropriate physician documentation on the patient record.” Another 20% listed “accurate coding, including accurate use of new [POA] codes”; 16% checked “interdepartmental collaboration for identification and documentation of health care–acquired conditions”; and 13% selected “physician education on the impact of the CMS rule” on reimbursement for health care–acquired conditions. “Everybody’s worried about the [POA] issue. They view it as intrusive, something that could potentially create new costs and all sorts of other things,” Dr. Daniel Varga, chief medical officer of St. Louis–based SSM Healthcare, said in an interview. But “it’s probably going to be more of an issue of doctors’ needing to be educated, and for us to build processes to make it easy to document presence or absence of [HAIs].” In a keynote speech, Dr. Thomas B. Valuck, medical officer and senior adviser at CMS, described the new rule as part of the agency’s overall “value-based purchasing” strategy. Until now, “Medicare’s fee-for-service schedules and prospective payment systems [were] based on resource consumption and quantity of care, not quality or unnecessary costs avoided,” Dr. Val- uck noted. If spending continues at the current rate—projected at $486 billion for 2009—the Part A trust fund will be depleted by 2019, he said. This is the reason for the focus on hospital-acquired infections, which are estimated to add nearly $5 billion annually to the national health care tab. A 2007 study found that, in 2002, 1.7 million hospital-acquired infections were associated with 99,000 deaths. Yet that survey, conducted by the employer/insurer coalition known as the Leapfrog Group (www.leapfroggroup.org), found that 87% of 1,256 hospitals were not consistently following recommendations aimed at preventing many of the most common hospital-acquired infections, Dr. Valuck said. The three types of infections designated for nonpayment are among a list of 10 health care–acquired conditions that Medicare no longer covers (and for which CMS has mandated reporting for the last year). The list includes “never events” such as foreign objects retained after surgery, blood incompatibility, and other conditions such as manifestations of poor glycemic control and injury after a fall (SURGERY NEWS, September 2008, p. 1). All 10 health care–acquired conditions are subject to the “present on admission” documentation requirement, which defines as POA any conditions present at inpatient admission, including those that arose during outpatient encounters in the emergency department, observation, or outpatient surgery. The APIC survey also highlighted other challenges imposed by the new rule. Nearly two-thirds (59%) of respondents said that their institution’s current surveillance process for detecting problem pathogens and potential HAIs that need investigation was “reasonably timely and efficient” but had “room for improvement,” while 16% said that the process was “not timely and efficient.” Also, 72% said that HAI elimination measures were “moderately” integrated into the tasks of clinicians and other staff; 9% felt that the measures were “very well integrated,” and 17% said the measures were “only indirectly integrated.” Asked about the biggest challenge for their organization regarding HAI prevention, 36% listed “measuring compliance with infection prevention practices, such as hand hygiene,” and 30% chose “timely and efficient tracking of all or targeted HAIs across the hospital population.” Among specific HAI prevention interventions, 55% of respondents said removal of unnecessary indwelling urinary catheters was the most challenging for their organizations; smaller proportions listed avoidance of central line–associated infections (22%), antimicrobial prophylaxis for preventing surgical site infections (16%), and interventions for preventing ventilator-associated infections (6%). ■ AHRQ Awards $3 Million for Bloodstream Infection Prevention BY MIRIAM E. TUCKER Else vier Global Medical Ne ws for Research awarded $3 million The Agencyhas Healthcarea Quality and 3-year contract aimed at reducing central line–associated bloodstream infections in hospital intensive care units nationwide by implementing a comprehensive intervention, which proved to work at Johns Hopkins University in Baltimore and in the state of Michigan. The new funding was announced in a telephone press briefing on Oct. 1, the day that Medicare’s new rule of nonpayment for certain hospital-acquired infections— including central line–associated bloodstream infections—went into effect. “The need to align payment with the quality of care delivered is long overdue, and this policy today is really a large first step toward that goal. I believe we have to pull as many different levers as we can to solve these problems,” said Dr. Peter J. Pronovost of Johns Hopkins University, when asked to comment on the connection between the Medicare policy and the new AHRQ funding. The AHRQ grant, to be awarded to the Health Research and Educational Trust, an affiliate of the American Hospital Association (AHA), continues the agency’s previous funding for work led by Dr. Pronovost initially at Johns Hopkins and subsequently by his group in collaboration with the Michigan Health and Hospital Association. The multifaceted intervention included five evidence-based procedures (hand washing, full-barrier precautions during catheter insertion, site cleaning with chlorhexidine solution, avoiding the femoral site, and removing unnecessary catheters). Intensive care units also used daily goals sheets to improve communication among clinicians, a comprehensive unit-based safety program, and an intervention to reduce ventilator-associated pneumonia. Data on infection rates were collected monthly for up to 18 months (N. Engl. J. Med. 2006;355:2725-32; J. Crit. Care 2008;23:207-21). The 103 participating Michigan hospitals reported on a total of 1,981 ICUmonths of data on 375,757 catheter-days. The median rate of catheter-related bloodstream infections per 1,000 catheter-days decreased from 2.7 infections at baseline to 0.0 at 3 months, which was maintained through up to 18 months of follow-up. The mean number of infections dropped from 7.7 at baseline to 1.4 at 16-18 months. “The findings from Michigan were incredibly dramatic This is the largest study published, with the most dramatic improvements for any of the quality and safety problems facing our nation’s health care system,” AHRQ director Dr. Carolyn M. Clancy said, noting that an estimated 250,000 cases of central line catheter–associated bloodstream infections occur every year in hospitals in the U.S., leading to 30,000-62,000 deaths. What makes his study so unique, according to Dr. Pronovost, is its scientific focus on the delivery of health care. “Part of the failure to deliver safe care is [a result of the fact that] we haven’t viewed in a scientific way how to deliver care. Science is typically limited to finding genes or finding drugs, but that really messy practice of medicine has been relegated to the art, and we dramatically underfund studies of it.” Now that AHRQ has followed up its initial support with the new grant, “We’re ready to go full steam ahead” in expanding the program’s reach, he commented. Over the next 3 years, AHRQ’s funding will be used to train staffs at ICUs in 10 or more hospitals in 10 states, said Dr. John R. Combes, president and chief operating officer of the Center for Healthcare Governance at the AHA. He is also interim president of the AHA’s trust that is receiving the grant and that will be conducting the trainings in collaboration with teams from Johns Hopkins, Michigan, and from state hospital associations. Ultimately the plan is to expand the intervention to the entire country. “The project has great potential to significantly reduce infections on a national level,” Dr. Combes said. In addition, Dr. Pronovost said, the intervention should be applicable to inpatient settings other than ICUs, which were chosen for the study primarily because that’s where the majority of central lines are placed and where the most accurate data are collected. “The strategy was lick ’em in the ICU, show that the rates come down, and then have those teams take this to the operating rooms and emergency departments. That’s indeed what happened in Michigan, and that’s what we hope will happen [elsewhere],” he sa http://www.leapfroggroup.org http://www.leapfroggroup.org http://www.facs.org

Table of Contents Feed for the Digital Edition of Surgery News - November 2008

Surgery News - November 2008 Contents News:�Without a Stitch The 20/20 Vision:�Med School Mix News From the College:�New President General Surgery: Diabetes Debate

Surgery News - November 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.