Hospitals Profit On Bloodstream Infections
"We wanted to see, let's try to find out where the dollars flow so we could better align incentives."
I also asked Susan Pisano, spokeswoman for America's Health Insurance Plans, and she says they are taking action. Sort of.
"Health plans are moving briskly toward new payment models, whether they are global, bundled, or ACOs," she says. "They pretty much all contain incentives and or bonuses in physician payments to improve quality. And much more are being geared to the hospital side."
However, she says, it's not the health plan's responsibility to pay for hospital improvements that prevent infections. "The fees that health plans have negotiated with hospitals already include setting up systems and quality improvement work that hospitals do."
That said, she adds, there are some initiatives. WellPoint, for one, is involved in just such a program.
Against the backdrop of the recent release of hospital pricing data, the issues Pronovost raises are all the more compelling. Now he, or someone with his energy and expertise, needs to broaden the research to include health plans, which are businesses just like hospitals.
It might just keep a few patients alive. According to the Centers for Disease Control & Prevention, as many as 13,300 critical care patients developed CLABSIs in 2011, with a mortality rate of 12% to 25%.
That's a lot of cost, and a lot of death. We know both can be prevented.
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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