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Pressure Mounts to Fight Healthcare-Associated Infections in NJ

Some improvements seen in state report, but federal regulations propose added penalties for hospitals that don't do better.

Kathy Duncan, a registered nurse and a faculty member with national nonprofit the Institute for Healthcare Improvement
Kathy Duncan, a registered nurse and a faculty member with national nonprofit the Institute for Healthcare Improvement.

New Jersey’s hospitals have made some progress in reducing the infections that patients develop while in healthcare facilities, and they will soon be feeling more pressure to improve further.

A state report found that New Jersey hospitals’ performance improved or held steady in four of the five types of healthcare-acquired infections compared with 2010.

But those hospitals could be under increased pressure to continue to improve in coming years, as a result of proposed federal regulations that would cut Medicare payments for providers where hospital-associated infections do not continue to decrease.

The report found that state hospitals did not do as well preventing infections from coronary artery bypass grafts as they did in past years. But state officials pointed to strong performance in reducing central line-associated bloodstream infections. State hospitals had 27 percent fewer of those infections than was expected based on national data.

The data on healthcare-associated infections was one of three sections to the state report, which also found improvements in hospitals’ performance in maintaining recommended processes for providing care, as well as in other patient safety indicators.

“New Jersey hospitals have been moving in the right directions,” state Health Commissioner Mary E. O’Dowd said of the report.

The annual report was based on the most recent data, which ran through 2011. However, a New Jersey Hospital Association report released in May, which focused on a separate but more recent set of data, also found improvements in 2012.

The issue of healthcare-associated infections, which include both those acquired in hospitals and in other healthcare facilities, is gaining increased attention from hospital officials, according to Suzanne Dalton, program manager for Healthcare Quality Strategies Inc.

“There’s a change in the emphasis” toward reducing healthcare-associated infections, said Dalton, whose organization has a contract with the federal government aimed at helping providers improve healthcare quality. “The dollars are shrinking, the dollars continue to shrink, so while everybody used to say, ‘You had to do more with less,’ it’s even greater at this point,” she said.

Dalton said hospital executives haven’t always understood the importance of investing in reducing in-hospital infection -- both directly through more testing of patients and indirectly through time spent by hospital staff to learn about safety procedures. But pressure from the federal government and insurers is starting to have an effect, she said.

“It’s really hitting the pocketbook,” Dalton said.

Dalton said the new emphasis on reducing infections would be just as important even if the federal government wasn’t cutting payments. That’s both because it will lead to healthier payments and because it can head off more expensive treatments later. She noted that 1,000 people receiving a $50 test may be expensive for a hospital, but early detection of bacteria could prevent spending 10 times as much to readmit and treat a patient with a dangerous hospital-acquired infection.

This approach may actually lead to hospitals growing their revenue, she said.

“You may not necessarily have to build more orthopedic beds if you educate your patient well, they do well, they get out faster, and you bring the next orthopedic patient in,” she said.

This emphasis on reducing infections was reflected in a recent educational session for healthcare quality professionals, the hospital workers who are focused on reducing infections.

Kathy Duncan, a registered nurse and a faculty member with national nonprofit the Institute for Healthcare Improvement, noted that hospitals have seen improvements in reducing infections by taking steps like having patients use a special soap for three days prior to a surgery and screening patients for the presence of dangerous bacteria prior to an operation.

Duncan suggested that healthcare quality professionals screen a small number of patients -- which may turn up several patients with potentially dangerous bacteria. They can use those results to argue with hospital administrators for expanded screening.

“That’s a pretty powerful argument,” Duncan said of screening results.

Another powerful argument may be the proposed federal regulations, which stipulate cuts to Medicare payments to hospitals that do not reduce healthcare-associated infections. The regulations are part of the annual process that the Centers for Medicare & Medicaid Services uses to set payments to hospitals. Federal officials are expected to finalize the changes in August.

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