Hospitals can reap a windfall when an insured patient has a preventable infection, and private health plans—not Medicare—foot the largest bills. Why aren't these payers doing more to help hospitals prevent infections?
Hospitals profit exorbitantly when privately insured patients get bloodstream infections and thus have "no incentive to invest in prevention," says hospital safety guru Peter Pronovost, MD.
"We've known hospitals profit from complications," the Johns Hopkins Medicine patient safety expert said in a phone interview Wednesday. "But we've never before had a study that looked at both the impact to the health insurer's pocketbook and the impact on hospitals, and seen how these dollars flow."
Here's another pie in the face of the healthcare payment system, since it follows a similar report last month from Atul Gawande, MD, and colleagues. They documented financial bonanzas for hospitals whose surgical patients developed complications such as strokes or blood clots. That report follows a noteworthy Health Affairs blog post last fall that said pay-for-performance efforts haven't documented improved patient outcomes.
What Pronovost, co-author Eugene Hsu, MD, and others found, published in the current online edition of the American Journal of Medical Quality, is both "unique" and "mind-boggling," Pronovost says. It points the finger at health plans and raises the question of why they shouldn't help hospitals do better.
Infected patients cost five times more
Although there were only 16 qualifying central line-associated bloodstream infections or CLABSIs, and only one hospital intensive care unit was involved in this study—flaws Pronovost acknowledges—the differences in cost were stunning depending on the payer.
Health plans got stuck with paying $494,655 to care for an infected patient, compared with $99,752 to care for a similar, matched patient who didn't get an infection. Government payers Medicare and Medicaid paid less, but the gap was still wide: About $154,832 per CLABSI patient compared with $58,237 for a matched patient without, the report says.