Positive, forward-looking healthcare stories seem to come in clusters, and this time there were four. Here comes another, so make that five.
Four of the stories tell how providers are starting to successfully chip away at some of their most vexing iatrogenic conditions, specifically nosocomials, hospital-acquired infections, or HAIs.
These are avoidable mishaps, mistakes, or errors that cause harm. They make patients sicker, prolong hospital stays, complicate providers' lives and are very expensive for everyone. Changing the practice as well as the culture is or should be paramount.
Here are these good news stories showing ways the system is changing.
1. Health-care associated invasive methicillin-resistant Staphylococcus aureus (MRSA) infections have declined 9.4% per year from 2005 through 2008, a 28% decrease in all hospital-onset MRSA, says a report published Wednesday in the Journal of the American Medical Association.
MRSA prevention practices underway in many U.S. were said to be possibily responsible for the downturn in this study covering nine metro areas and 15 million people.
2. Also on Wednesday, an article in the journal Emerging Infectious Diseases published by the Centers for Disease Control and Prevention, shows how the age-adjusted rate of hospitalization for patients diagnosed with peptic ulcer disease decreased by 21% (from 71.1 per 100,000 population to 56.5) between 1998 and 2005.
The decline was subsequent to the 1997 launch of an educational campaign by federal agencies, academic medical institutions, and private industry to promote use antimicrobial drugs against the bacteria.
3. Last week, a report from the University of California found that computerized infection monitoring systems help hospitals track and fight healthcare-associated infections. What's more, those hospitals that use these systems are more likely to have fully implemented other evidence-based practices to reduce MRSA than those hospitals that used manual systems to track infections.
4. In late May, the CDC held a forum to announce that the 17 states that mandate hospital reporting of central line bloodstream infections had 18% fewer rates of infections compared with the three previous years.
The report was hailed as "a turning point in transparency and accountability for healthcare" by Peter Pronovost, MD, medical director of the Center for Innovations in Quality Patient Care at Johns Hopkins University who is credited for developing a five-step CLABSI prevention checklist.
But it is the fifth story that may drive quality improvements farther and faster than any of the others.
5. The Centers for Medicare and Medicaid Services has announced that starting Jan. 1, 2011, any hospital that accepts Medicare patients—as most do—will have to report to the CDC their central line associated bloodstream infections that occur within intensive and neonatal intensive care units or go without a pay increase the following year.
In 2012, surgical site infection reporting will begin with similar payment incentives.
Those infection rates will be included in the impossible-to-pronounce RHQDAPU, which stands for "Reporting Hospital Quality Data for Annual Payment Update."
And here's another really important part of this fifth story: Sometime next year, as soon as Medicare thinks it has enough reports, those hospital-specific infection rates will start showing up on CMS's Hospital Compare website, along with hundreds of other cost, outcome and process measures for each facility that receives Medicare reimbursement in the country.
Using the site, health executives, payers, employers, physicians, recruiters, and yes, lots of consumers will be able to view and compare data on 3,500 hospitals. Will companies that buy healthcare go to that site to make purchasing decisions? Some of my colleagues think they will not. But I think they will, in time.
Mike Bell, MD,deputy director of the division of Healthcare Quality Promotion for the CDC wrote on his blog:
"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."
Down the line, many health leaders say they fully expect CMS to take additional steps to more severely penalize hospitals with higher than normal preventable mishaps.
In releasing its July 30 final rule, CMS made a point of explaining that to date, with 12 months of claims data recorded, CMS has adjusted—which is to say lowered—payments by $18.8 million for 3,416 patient discharges in which any of 10 current hospital-acquired conditions had occurred.
Those 10 are: foreign objects retained after surgery, air embolism, blood incompatibility, stage three or four pressure ulcers, falls or trauma, poor glycemic control, catheter-associated urinary tract infection, vascular catheter associated infections, surgical site infections following certain procedures, deep vein thrombosis and/or pulmonary embolism.
As CMS says in its fact sheet, the agency "continues to believe that this policy (of using financial reward, measurement tools, performance results and enforcement of conditions of participation) plays an integral role in promoting quality of care and considers it to be part of an array of Medicare VBP (value based purchasing) tools that CMS believes will promote increased quality and efficiency of care."
It is, the agency says, "transforming Medicare from a passive payer to an active purchaser of higher value healthcare services."
A new era in healthcare is being launched. And it is indeed good news.