The rate of hospital-acquired infections is much too high. About 4% of all hospitalized patients have an HAI at any given point in time[1] . We suffer 700,000 HAIs and 75,000 deaths per year in the US[2] .
This is bad, no question about it. But it is also remarkably better than just a few years ago. The number of HAIs in 2002 was estimated at 1.7 million[3] , about two and a half times higher. The rate of HAIs is dropping rapidly[4] , including:
- A 50 percent decrease in central-line associated bloodstream infections between 2008 and 2014
- A 17 percent decrease in surgical site infections 2008–2014
- An 8% decrease in C. difficile infections 2011–2014
- A 13% decrease in MRSA bloodstream infections 2011–2014
From Zero Tolerance for Deadly Hospital-Acquired Infections
Why the progress? It’s all about incentives.
Before 2009, patients who acquired infections were a revenue source for hospitals. They would simply bill the insurer (usually Medicare) for the additional care. More infections meant more revenue.
I don’t mean to imply that providers were indifferent to HAIs. But the CEOs and CFOs that actually run hospitals and set policy probably were. HAIs simply were not a problem that threatened a hospital’s bottom line.
What changed in 2009? You guessed it – Obamacare passed. Medicare began implementing a system where a lump sum is paid for the condition the patient was diagnosed with on admission (this is called DRG coding). It also started tying hospital’s rates of reimbursement to quality metrics, including HAIs. It became much harder for hospitals to get reimbursed for infections that patients acquired after admission – this was now on the hospital, and HAIs became cost centers rather than revenue generators.
This got the attention of the C-suite. All hospitals had infection control officers before, but they were usually nurses nearing retirement. Their job was to nag doctors to wash their hands and they were ignored. But with real money on the line, hospital CEOs began demanding accountability for HAIs, and they got it.
The Medicare quality initiatives have been a huge success, saving thousands of lives and billions of dollars. But they suffer from a fatal flaw: association with Barack Obama. Therefore their eradication is a top Republican priority. Like so many other top Republican priorities, this one will screw over the very people who put them in power (HAIs predominantly afflict the elderly) .
Would suing hospitals for HAIs be an improvement over the current system?There is a certain rough-justice appeal to this idea. After all, we go to hospitals to get better, not to get sicker. There should be accountability for failure.
But some number of HAIs are inevitable. You put a bunch of sick people – many with compromised immune systems – together in a building, have a bunch of other people running around between them, frequently puncturing their skin, and you are going to get HAIs.
The Law of Unintended Consequences would be unleashed in all its awfulness. The risk factors for HAIs – both who will get them and what procedures cause them – are well-known. If hospitals are faced with ruinous lawsuits over HAIs, they will begin to game the system – refusing to admit high-risk patients, avoiding procedures that expose the hospital to financial risk.
Ultimately, hospitals would not pay these costs anyway. They would either pass them on or close up. Who would they pass them on to? Insurers, both private and governmental. And who would insurers pass these costs on to? Do I really have to say?
It’s not well-known, but we actually have a pretty good system in place now for controlling HAIs. It can and should be improved. The disruption caused by involving the legal system would not serve society well.
Footnotes
[1] Health Care Associated Infections
[3] Estimating health care-associated infections and deaths in U.S. hospitals, 2002.