"But now we know that factors triggering people into that outlier status—such as CLABSIs—are indeed preventable. It's not a random illness."
Outlier patients are defined as those who require such intense care, that estimated hospital costs exceed a threshold, and "hospitals receive both a fixed rate and an additional amount equal to 75% to 80% of the charges beyond that loss threshold."
Under this system, which gives "windfall" profits to hospitals for treating outliers, Pronovost says, hospitals have had no incentive to implement "quality management infrastructure," like protocols and personnel, necessary to prevent patient harm, such as CLABSI.
"There's the Centers for Medicare & Medicaid Services' Partnership for Patients initiatives to reduce 10 types of harm. Yet when you look at what hospitals are working on, it's just one or two types of harm, not because their patients aren't at risk, but because they can't afford it."
PPACA pay cuts hurt
The Patient Protection and Affordable Care Act's "main mechanism to control costs is to pay hospitals less," Pronovost says. And that is starting to backfire. "Hospitals say, 'OK, I'm going to cut my quality programs. My nurses will care for seven patients instead of five,' which we know will make complications go up. Hospitalists will care for 20 patients instead of 10. But again, you have a positive bottom line."
Perhaps a more effective way, rather than just paying hospitals less, would be for payers who have a lot more skin in the game, like insurance plans, to financially support hospitals to build these infrastructures.