The Centers for Medicare and Medicaid Services last week expanded its popular Hospital Compare website to include outpatient data related to areas such as hospital 30 day mortality rates and 30-day readmission rates for patients with heart failure, heart attacks, and pneumonia. But one critical health issue is still missing from the national database: the rate of healthcare-associated infections (HAIs) occurring in hospitals.
That's certainly not to say CMS is ignoring the issue. Since 2008, CMS said it would no longer make additional Medicare payments related to certain HAIs obtained in the hospital such as catheter associated urinary tract infections or vascular catheter associated infections.
And, under the healthcare reform legislation approved earlier this year, Hospital Compare—beginning in October 2014—will finally report hospitals' records for several infections covered by Medicare's policy of nonpayment for hospital acquired conditions.
The Department of Health and Human Services also has moved forward with a five-year action plan to tackle HAIs. But it just may not be enough, some consumer groups are saying. These organizations are urging HHS and CMS to go further and adopt proposed regulations that will require all hospitals to disclose how many patients develop certain infections during treatment.
"The goals in this action plan are extremely conservative. When we commented on the action plan, we said that [they] needed to have higher goals," says Lisa McGiffert, director of Consumers Union's Safe Patient Project in Austin, TX. McGiffert helped author a letter on behalf of consumer groups to CMS responding to the plan and pending legislation on reimbursement issues.
"Our feeling was that if this was where we were going to be five years from now, we're in trouble. We need to be much further along," McGiffert says. And it can be done. "We're seeing great progress in hospitals that have implemented the bundles of prevention activities. Some of them are getting their infections down to zero and keeping that over a long period of time."
If efforts "fall short to stop this epidemic," McGiffert says, "10 million hospital patients will get an infection over the next five years and a half a million of them will die," she adds. "We definitely need accountability."
An ongoing effort can be seen in the states that have passed legislation requiring specific HAI reporting plans to be in place. Only one state, though—Pennsylvania—has been publicly releasing hospital-specific data related to HAIs to the public.
To assess whether the HHS's action plan's metrics and targets are being met, it will be necessary to reveal these results to the public in "a meaningful way"—or at the hospital level, McGiffert says.
A proposed federal regulation to report central line bloodstream infections in ICU patients and surgical infection, for instance, is a start toward this accountability—but it does not go far enough, says McGiffert.
All of the HAI targets should be included in the public reporting proposal—especially measures relating to MRSA, c.difficile, urinary tract infections, and ventilator associated pneumonia.
Some strides are being made in pushing the rates of various HAIs down. For instance, in late May, the Centers for Disease Control and Prevention released a first-ever report showing that U.S. healthcare facilities reduced the rate of central line associated bloodstream infections—which claim the lives of 30,000 patients each year—by 18%.
The new report is based on surveillance data collected through the CDC's healthcare associated infection monitoring system, the National Healthcare Safety Network. NHSN is now used among 21 other states as well to collect data, McGiffert notes.
While not all HAIs are preventable, the Association for Professionals in Infection Control found that a number of its member facilities have seen their central line associated bloodstream infections reduced—sometimes to zero—and that in many instances "zero" can be maintained.
This is information that the public would be interested in seeing—the sooner the better. So if public reporting of infection rates can serve as a powerful tool for holding hospitals accountable for reducing infection risks and keeping patients safe, why wait for data five years from now?
Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.