The Centers for Disease Control (CDC) estimates 250,000 central line-associated infections occur in the United States annually with an attributable mortality rate of 12 to 25 percent.
Hospitals with highly focused programs report bloodstream infection rates between two and five percent. The one thing that doesn’t vary is the high cost of treating these infections.
Beginning Oct. 1, 2008, the Centers for Medicare and Medicaid Services (CMS) will no longer provide reimbursement over and above the typical Inpatient Prospective Payment System (IPPS) rate for care required to battle several types of healthcare-associated infection, also referred to as hospital-acquired infection (HAI).
CMS collaborated with the Centers for Disease Control and Prevention and other healthcare groups to identify a number of hospital-acquired conditions that were high volume, high cost, or both and “could reasonably have been prevented through the application of evidence-based guidelines,” as mandated by Section 5001(c) of the Deficit Reduction Act.
The final rule states, hospitals “will not receive additional payment for cases in which one of the selected conditions was not present on admission. That is, the case will be paid as though the secondary diagnosis was not present.” Those “selected conditions” include:
- Serious Preventable Events (Objects Left in During Surgery, Air Embolism, Blood Incompatibility)
- Catheter-associated Urinary Tract Infections
- Pressure Ulcers
- Vascular Catheter Associated Infections
- Surgical Site Infection - Mediastinitis after Coronary Artery Bypass Graft
- Fall and Trauma - Fractures, Dislocations, Intracranial Injuries, Crushing Injuries and Burns.
Costs & Reimbursement:
- A single incident of CRBSI can cost as much as $56,000 to treat, once the cost of pharmacy charges, catheter changes, lab tests and an additional day in the ICU are totaled up.(1)
- Michele Lee, RN, CRNI, a vascular access expert and President of Lee Medical based in Nashville, TN quoted these facts: “The average cost to treat a CRBSI is $91,000 … that’s the average”. “Currently, the average reimbursement is about $67,000 – an operational loss of $24,000. As of Oct. 1, 2008, reimbursement will be zero. Obviously, this negative financial impact will quickly erode the provider’s bottom line.”
- Research by Richard P. Shannon, M.D. showed an average $26,839 loss to the hospital for each patient who came down with a central line-associated bloodstream infection (CLAB). The average payment for a case complicated by CLAB was $64,894, and the average expense was $91,733.
“The elimination of these preventable infections constitutes not only an opportunity to improve patient outcomes but also a significant financial opportunity.” (2)
- It has been estimated that each year in the United States a total of 250,000 cases of CVC-associated BSIs occur. Approximately 80,000 of these infections occur in ICUs. The overall attributable mortality rate is estimated to be between 12% to 25%; it remains unclear as to the rate for critical care patients. The attributable cost per infection is an estimated $34,508--$56,000 while the annual cost of caring for patients with CVC-associated BSIs ranges from $296 million to $2.3 billion. (1)
(1) O'Grady, N.P., Alexander, M., Dellinger, E.P., Gerberding, J.L.,Heard, S.O., Maki, D.G., Masur, H., McCormick, R.D., Mermel, L.A., Pearson, M.L., Raad, I.I., Randolph, A., Weinstein, R.A. "Guidelines for the Prevention of Intravascular Catheter-related Infections." The Centers for Disease Control, August 9, 2002, Vol. 51, No. RR10, pp. 1-26.
(2) Shannon R.P., Patel B., Cummins D., Shannon A.H., Ganguli G., Lu Y. Economics of central line-associated bloodstream infections. American Journal of Medical Quality, 2006. Vol. 21, No. 6 suppl, 7S-16S.
The Joint Commission
The Joint Commission's goal is to continuously improve the safety and quality of care provided to the public through the provision of healthcare accreditation and related services that support performance improvement in healthcare organizations.
Institute of Healthcare Improvement
5 Million Lives Campaign
The 5 Million Lives Campaign is a voluntary initiative to protect patients from five million incidents of medical harm over the next two years (December 2006 – December 2008).
- IHI 5 Million Lives Website
- Implement the Central Line Bundle
- Products Designed to Help Reduce HAC's
- Centers for Medicare & Medicaid Services (CMS) website
- Infectious Diseases Society of America (IDSA) website