The return on investment would be "enormous. It's mind-blowing really," he says. "To think that an insurer could save $400,000 preventing one infection. That $400,000 would support an entire improvement project; our whole Michigan [Michigan Health and Hospital Association's Keystone] project, for example, cost only $500,000."
How would hospitals replace the revenue they now get when insured patients develop CLABSIs? For starters, with beds now empty, they could admit more patients and receive more DRG payments. If there weren't more patients needing admission? Well, Pronovost says, "maybe we have too many hospital beds in this country."
Pronovost says his research project was possible only because an insurance company, Blue Cross Blue Shield of Hawaii, and a hospital, Queen's Medical Center in Honolulu, agreed to cooperate.
"It required a great deal of trust for both of these groups to open up and be transparent about whose pocket a complication benefits, and who is paying. And because we focused on CLABSIs, which are almost entirely preventable, [the hospital] can't say this is a complication that we can't prevent. Because we can. We know there's no excuse. We know many hospitals can go for a year or more without having even one."
I asked Pronovost why health plans, which presumably are well aware how much they pay for these infections, hasn't seen on its own, what great business sense this makes.
"Everyone thought the buck was passing to someone else," he explains. "Insurers would often say, 'Well, we're paying for these infections but we don't really think we're saving a lot of money from investing in them.' The hospital CEOs said, 'Peter, I lose money when I prevent infection. It's good for the patients. But the insurers get a windfall.' "