Pennsylvania Finds High Toll
In Hospital-Acquired Infections

RHONDA L. RUNDLE / Wall Street Journal 13jul2005

Last Year in Pennsylvania:
11,668 hospital-acquired infections
1,510 deaths
205,000 extra hospital days
$2 billion in hospital charges

[Agency press release below]

There is strong new evidence that quality lapses in the form of hospital-acquired infections add to the high cost of U.S. health care.

Last Year in Pennsylvania:
Infections       = 11,668
Deaths           = 1,510 deaths
Extra hosp days  = 205,000
Charges          = $2 billion

Rates scaled up for US population*:
Infections       = 274,407
Deaths           = 35,512
Extra hosp days  = 4,821,175
Charges          = $47 billion

In the first study of its kind, a Pennsylvania state agency has found that 11,668 hospital-acquired infections were associated with an additional 1,510 deaths, 205,000 extra hospital days and $2 billion in hospital charges last year. The findings came from data provided by 173 hospitals across the state.

Pennsylvania is at the forefront of a nationwide consumer campaign to require hospitals to publicly report their infection data. Five states, including Illinois and Missouri, have adopted laws to require regular reports of hospital infections and many others have similar measures pending. New York Gov. George Pataki is expected to act shortly on a bill that the state legislature passed last month.

"Eyes glaze over when you talk about health-care quality, but when you see how many people are dying and the cost impacts, it's pretty overwhelming," said Marc P. Volavka, executive director of the Pennsylvania Health Care Cost Containment Council, an independent state agency. The study found 7.5 hospital-acquired infections per 1,000 admissions to the state's hospitals last year. And there are indications that hospitals are sharply underreporting their infections, so these data are "the tip of the iceberg," Mr. Volavka said.

"This is a day for real celebration that we finally have a major state with a substantial characterization of things that are going wrong in the health and medical-care business," said Paul O'Neill, former Treasury Secretary in the Bush administration who is an advocate of health-care-quality initiatives. "Most, if not all, of these infections could have been avoided with standardized procedures that we know about," he added.

Studies have shown generally poor hospital compliance with known infection-control techniques. Physicians frequently fail to wash their hands before examining patients, for instance. Some hospitals fail to administer antibiotics in a timely way before surgery. While no one knows how many hospital-acquired infections are preventable, there is consensus that the rates could be cut sharply. Meanwhile, rates are rising with increased use of invasive devices, such as catheters, as well as the spread of antibiotic-resistant bacteria.

There is no reason to think that Pennsylvania hospitals are any better or worse at controlling infections than those in other states. Extrapolating from the Pennsylvania data to the rest of the country suggests that more than 125 people a day are dying from hospital-acquired infections with an associated $50 billion of related hospital charges every year, Mr. Volavka estimates. Hospital charges are list prices similar to automobile sticker prices, so the actual payments by health insurers and individuals are generally much lower.

Nevertheless, the Pennsylvania agency believes that the data submitted by the state's hospitals account for only a fraction of the hospital-acquired infections last year, based on a discrepancy between the hospital reports and the number of infections that were billed by hospitals. According to the agency, hospitals reported 11,668 infections in 2004 but in 2003 billed for about 10 times as many, or 115,631 of them.

Hospitals are making their best effort to meet the council's mandate, but it takes time to understand how to report their findings in a way that meets the council's requirements, said Carolyn F. Scanlan, president and chief executive officer of the Hospital & Healthsystem Association of Pennsylvania, whose members include most of the state's nearly 200 general hospitals. "I can guarantee that the number of infections will increase, but I don't believe it will be a tenfold increase," she said.

The billing information creates a misleading picture because it doesn't adequately adjust for infections that a patient brought into the hospital, Ms. Scanlan said. She stressed that the reporting project is a work in progress. "The optimal goal would be to get hospital-acquired infections to zero, but nowhere in the literature does anyone indicate how fast or how to get there," she said. Pennsylvania also has a large elderly population, which is prone to community-acquired infections, she added.

But even though the report doesn't offer a complete picture for all hospitals in the state, "it reveals unacceptable costs in lives and dollars to health-care consumers," said Betsy Imholz, director of the West Coast regional office of Consumers Union, a nonprofit testing and information organization that publishes Consumer Reports. Others states are watching Pennsylvania closely to see how it implements the state's infection-reporting rules, she added.

Page D4

11,668 confirmed hospital-acquired infections in 2004 in Pennsylvania  

First State Report on Hospital-Acquired Infections
Released in Pennsylvania

Cost, Quality Issues Raise Grave concerns

Press Release /  13jul2005

In the first report of its kind, Pennsylvania hospitals reported 11,668 confirmed hospital-acquired infections in 2004, according to a Research Brief titled Hospital-acquired Infections in Pennsylvania released today by the Pennsylvania Health Care Cost Containment Council (PHC4).

The hospital admissions in which these infections occurred were associated with 1,793 deaths, and an estimated 205,000 extra hospital days and $2 billion in additional hospital charges. These numbers are out of a total of 1.5 million discharges from 173 general acute care hospitals.

"This seminal report demonstrates without question that the cost and quality implications of potentially preventable hospital infections are astounding," stated Marc P. Volavka, Executive Director of PHC4. "This first snapshot of statewide numbers should be a wake up call for all parties involved in the delivery and payment of hospital care."

Pennsylvania is the first state in the nation to begin collecting and reporting information about hospital-acquired infections. Beginning in 2004, hospitals were required to start submitting data on four types of hospital-acquired infections to PHC4: three surgical site infection categories; and Foley catheter-associated urinary tract infections, ventilator-associated pneumonia and central line-associated bloodstream infections. As of January 1, 2006 hospitals will be required to submit data on all hospital-acquired infections to PHC4.

During this process, PHC4 has expressed its concern regarding the wide variation in reporting levels among hospitals in the state. "As we started down this uncharted path, we said from the beginning that it would take time for Pennsylvania's hospitals to become accustomed to this reporting process, and the Council continually worked with individual hospitals and the Hospital Association of PA (HAP) to provide lenient timeframes and extensions to hospitals having difficulty," said Mr. Volavka.

However, 29 hospitals (17%), which account for 25% of ALL statewide admissions, reported more than half (50.6%) of the 11,668 hospital-acquired infections. Several large hospitals submitted invalid infection data for the majority of their discharges. Sixteen hospitals, including several large hospitals, reported no infections at all.

"The Council is continuing to work with HAP, and these hospitals, to encourage full compliance, and we believe overall that they are making a good faith effort. However, results from the first full year of data collection indicate that while some hospitals worked very hard to meet the hospital-acquired infection data collection requirements, other hospitals provided only minimal information," said Mr. Volavka. He noted there was a steady increase each quarter of 2004 in the number of hospital-acquired infections reported; yet, submission disparities among hospitals raised some concerns regarding the accuracy and completeness of the reported data.

"While we recognize and applaud the Pennsylvania hospital community for their significant participation in several new patient safety initiatives, including the Institute for Healthcare Improvement's 100,000 Lives Campaign (http://www.ihi.org/ihi), and the surgical infection prevention project with Quality Insights of Pennsylvania (QIP), the cost and quality implications of hospital-acquired infections cry out for continued focus and more resources," said Mr. Volavka.

One of PHC4's major interests is the discrepancy between the number of hospital-acquired infections reported by hospitals (11,668) and the 115,631 infections billed to purchasers, private insurers and government programs like Medicare and the state's Medical Assistance program. PHC4 screened the 2004 billing data for diagnoses that may possibly indicate the presence of a hospital-acquired infection. While it is reasonable to assume that not all these infections are acquired in the hospital, these billed infections suggest the possibility of more hospital-acquired infections than those confirmed by hospitals and reported to PHC4.

There has been no release of data on a hospital-by-hospital basis, he said, because this could penalize hospitals that have more fully and completely reported their data to PHC4. "We made a commitment to our hospital community that we would NOT release hospital specific data until we could reasonably assure ALL hospitals that we were comfortable with the accuracy and completeness of the reporting," said Mr. Volavka.

PHC4, also for the first time, was able to look at actual payment data for these occurrences. Previously, all cost assumptions were based on hospital charges, which are not what hospitals are actually paid in heavily discounted arrangements with insurance companies. The newly submitted payment data from third party payors shows that in 2003, the average payment for the treatment of a patient with an infection was more than $29,000, compared to an average payment of $8,300 for a patient without an infection.

"Those who pay for health care in Pennsylvania (and that's ALL of us) are paying four times as much for potentially preventable infections occurring every day in our hospitals" said Mr. Volavka.

Assuming payments remained static between 2003 and 2004, PHC4 estimates that third party insurance payments (distinct from hospital charges) for just the 11,668 reported infections were nearly $350 million annually. "Quality improvement efforts must be redoubled, and hospital Boards and CEOs, along with those paying the bills, must insure that infection control departments and their dedicated staff get the support and resources they need to reduce infections to the most minimally acceptable level. The quality case is imperative, the business case is compelling," stated Mr. Volavka.

The Pennsylvania Health Care Cost Containment Council is an independent state agency charged with collecting, analyzing and reporting information that can be used to make more informed decisions, thereby improving the quality and restraining the cost of health care in Pennsylvania.

Copies of the new Research Brief are free and can be ordered by calling PHC4 at 717-232-6787 or can be downloaded from PHC4's Web site at http://www.phc4.org

Contact: Joe Martin, Communications Director
717-232-6787 or jmartin@phc4.org

Research Brief: http://www.phc4.org/reports/researchbriefs/071205/docs/researchbrief2005report_hospacqinfections.pdf

source: http://www.medicalnewstoday.com/medicalnews.php?newsid=27389# 13jul2005