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Antibiotics Stewardship Enters Play-to-Pay Arena

By Philip Betbeze  
   April 07, 2016

Draft regulations from The Joint Commission say that all hospitals, regardless of size, must develop programs to combat antibiotic resistance. CMS is expected to follow that lead. Intermountain Health is already hard at work.

At some point in the very near future, your hospital may have to certify its adherence to a formal antibiotics stewardship program in order to receive reimbursement from Medicare.

Such rulings are known as conditions of participation. Meaning, if you don't participate, you don't get paid for treating Medicare patients.

But that's only the regulatory hammer that will ensure compliance. The real reason to get your antibiotics stewardship program under way is that it's one big piece of the puzzle toward combating antibiotic resistance, which is turning into a huge public health problem, says Edward Stenehjem, MD. He is medical director of the Urban Central Region Antimicrobial Stewardship Program and co-chair of the Antimicrobial Stewardship committee at Intermountain Healthcare in Salt Lake City.

Pushing back against antibiotic resistance is also a piece to the puzzle of your financial viability, given the increasing risk of infection from antibiotic-resistant pathogens that can wreck a reimbursement system that is moving closer to capitation.

Antimicrobial stewardship is the systematic effort to improve the quality of prescribing of antibiotics. It's useful not only in improving clinical outcomes, but also in attempting to decrease antimicrobial resistance and adverse events. Drug-resistant bacteria are on the rise, and hospitals are ground zero.

There are only a few ways to slow this trend, Stenejhem says.

"The most important is improving antibiotic use, and we do that through optimizing prescribing. There's not going to be a day where we don't use these drugs. They're miracle drugs, they're curative," he says.

"Regardless of appropriateness of use, their use will always drive resistance. The challenge is to use the least amount that's clinically necessary to slow antibiotic resistance."

At its current rate, matching the rise of resistance with new drug development and delivery is a losing battle, he says, making stewardship even more important.

'A Public health Issue'
Although development of stewardship programs is only one piece of the puzzle, it's the piece over which readers of this space have the most control and influence. But it requires a coordinated effort. Outpatient prescribing and rampant antibiotic overuse in livestock are other targets if an appreciable impact on resistance levels is to be achieved.

"This isn't a single-center issue. In order to have an impact, every hospital has to have program to address this," says Stenehjem. "It does us no good in the Salt Lake Valley if two hospitals prescribe appropriately when the other hospitals don't have these programs. So really, this is a public health issue."

That's one reason Stenehjem is speaking out, as an effort to help educate other healthcare organizations that perhaps don't know where to start. Intermountain uses a variety of well-tested techniques to encourage appropriate antibiotics use by its prescribing clinicians at all of its hospitals, and is willing to share advice and techniques.

That's a valuable resource, he says, because soon operating such programs won't be voluntary.

Stenejhem expects antibiotic stewardship programs to be mandatory, likely by 2017. In December 2013, a presidential executive order directed National Security Council staff to define strategies to conduct antimicrobial resistance prevention. Following the release of a report on how to address this, a 2015 national action plan was developed to combat antimicrobial resistance.

In that strategy, one of the core recommendations was to make antimicrobial stewardship mandatory under a CMS condition of participation. In November 2015, The Joint Commission released draft regulations mandating every hospital, regardless of size, to have to have stewardship programs. Stenehjem expects final language from the body on those regulations will be in effect by 2017.

Philip Betbeze is the senior leadership editor at HealthLeaders.

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