pennsylvania health care cost containment council (phc4) patrick j. brennan, head of a panel named...
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Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Patrick J. Brennan, head of a panel named by the secretary of Health Patrick J. Brennan, head of a panel named by the secretary of Health and Human Services years ago to advise the CDC on infection issues and Human Services years ago to advise the CDC on infection issues – while not taking a position on mandatory public reporting of – while not taking a position on mandatory public reporting of
infection rates –said:infection rates –said: ““There is no evidence to support public There is no evidence to support public disclosure as a means to reduce the incidence of these disclosure as a means to reduce the incidence of these infectionsinfections.”.”
Letter to the Editor - Marc P. Volavka, Executive Director, PHC4Letter to the Editor - Marc P. Volavka, Executive Director, PHC4
““Unfortunately, Dr. Brennan was only half right. There is Unfortunately, Dr. Brennan was only half right. There is no evidence to support public disclosure no evidence to support public disclosure because public because public disclosure of hospital-acquired infection has never disclosure of hospital-acquired infection has never occurred.”occurred.”
February 1, 2005
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Hospital-acquired InfectionsHospital-acquired Infections
In January 2004 PHC4 became one In January 2004 PHC4 became one of the first state agencies in the of the first state agencies in the nation to collect hospital data on nation to collect hospital data on infections contracted by patients infections contracted by patients while in the hospital.while in the hospital.
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Using the same definition as CDC’s National Using the same definition as CDC’s National
Nosocomial Infections Surveillance System Nosocomial Infections Surveillance System
(NNIS)(NNIS)
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
“ “ A localized or systemic condition… 1) A localized or systemic condition… 1) that results from adverse reaction to the that results from adverse reaction to the presence of an infectious agent(s) or its presence of an infectious agent(s) or its toxin(s), and 2) that was not present or toxin(s), and 2) that was not present or incubating at the time of admission to the incubating at the time of admission to the hospital.” hospital.”
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
In other words:
You didn’t come in with it, and you got it in the hospital…
How complicated is that?
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
PHC4 formed a Hospital-acquired Infection PHC4 formed a Hospital-acquired Infection Advisory Panel to help design data collection Advisory Panel to help design data collection processes.processes.
This expert advisory panel included infection This expert advisory panel included infection control professionals, physicians, medical records control professionals, physicians, medical records specialists and quality assurance representatives.specialists and quality assurance representatives.
And, we started to get And, we started to get results !results !
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Surgical site infectionsSurgical site infections for orthopedic surgery, for orthopedic surgery, neurosurgery, and surgery related to the neurosurgery, and surgery related to the circulatory systemcirculatory system
All device-related infections for:All device-related infections for: certain certain urinary tract infectionsurinary tract infections Ventilator-associatedVentilator-associated pneumonia pneumonia Central line-associated Central line-associated bloodstreambloodstream infection infection
Reporting Requirements Reporting Requirements - 2004- 2004
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
11,668 patients were confirmed by PA hospitals as 11,668 patients were confirmed by PA hospitals as having 4 types of HAI ... “tip of iceberg”having 4 types of HAI ... “tip of iceberg”
1,793 1,793 dieddied = 5 Pennsylvanians every day! = 5 Pennsylvanians every day! 205,000 extra days in the hospital205,000 extra days in the hospital
$2 BILLION in $2 BILLION in additionaladditional hospital billing that was hospital billing that was sent to someone to paysent to someone to pay
Hospital Acquired Infections in Hospital Acquired Infections in
Pennsylvania Facilities during 2004Pennsylvania Facilities during 2004
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Same report (using 2005 data)Same report (using 2005 data)
19,100 REPORTED HAI’s19,100 REPORTED HAI’s
12.2 per 1,000 cases12.2 per 1,000 cases
$3.5 BILLION charges in PA$3.5 BILLION charges in PA
394,000 hospital days!394,000 hospital days!
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
March 2006 – more research March 2006 – more research
New infections data showed more than New infections data showed more than $600 million in ACTUAL PAYMENTS!$600 million in ACTUAL PAYMENTS!
First-of-its-kind data in USAFirst-of-its-kind data in USA
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
PHC4 reported NOV. 2006:PHC4 reported NOV. 2006:
Payment data from third party payors shows that in 2005:
*The average payment for the treatment of a patient with an infection was nearly $54,000
*The average payment was $8,300 for a patient without an infection.
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
After almost three years of data After almost three years of data collection and reporting…collection and reporting…
PHC4 released the first hospital- PHC4 released the first hospital-specific report on specific report on Hospital-acquired Hospital-acquired
Infections in PennsylvaniaInfections in Pennsylvania on on November 14, 2006. November 14, 2006.
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
HAI Key FindingsHAI Key Findings
19,154 cases reported = 19,154 cases reported = 12.2%/1,000 cases12.2%/1,000 cases
394,129 hospital days394,129 hospital days
$3.5 billion in hospital $3.5 billion in hospital chargescharges
DOES PUBLIC DOES PUBLIC REPORTING REPORTING
WORK? WORK?
YES ! and it createsYES ! and it creates
SAVINGS OPPORTUNITIES!SAVINGS OPPORTUNITIES!
Now, as riveting as these Now, as riveting as these numbers are for the numbers are for the
person paying the tab; person paying the tab; here’s an equally here’s an equally
compelling “business compelling “business case” for a hospital CEO:case” for a hospital CEO:
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
CCU/MICU and HAICCU/MICU and HAIA Big Return on InvestmentA Big Return on Investment
Savings (1 hospital, 1 calendar yr)Savings (1 hospital, 1 calendar yr)
CLAB CLAB = = $1,235,765$1,235,765
VAP VAP = = $1,003,162$1,003,162
TOTAL HAI elimination initiatives = $2.2MTOTAL HAI elimination initiatives = $2.2M
Investment = $35,000Investment = $35,000
ROI = 63:1 !!!ROI = 63:1 !!!
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Hospital Investment NeededHospital Investment Needed
Dedication to process improvementDedication to process improvement Install automated system of measurement Install automated system of measurement
(Medmined or other)(Medmined or other) Measure infections! (you cannot improve Measure infections! (you cannot improve
what you do not account for and measure)what you do not account for and measure)
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Hospital Acquired Infections Hospital Acquired Infections are are NOTNOT inevitable, inevitable, nornor
unavoidable!unavoidable!
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
They are about broken They are about broken processes of care…and, processes of care…and, there there areare Hospitals, all Hospitals, all
across this country, that are across this country, that are beginning to demonstrate beginning to demonstrate
that HAI’s that HAI’s CANCAN be reduced be reduced or eliminated…or eliminated…
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Peer-Reviewed Medical JournalPeer-Reviewed Medical Journal
Three NEW articles on HAI’s, Nov/Dec 06Three NEW articles on HAI’s, Nov/Dec 06 Substantive medical evidenceSubstantive medical evidence Not reliant on patient case mixNot reliant on patient case mix Not age-associated Not age-associated Not associated with risk factors upon Not associated with risk factors upon
admissionadmission
WHAT IS LEFT?WHAT IS LEFT?
PROCESSES OF PROCESSES OF CARECARE
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
I’ll end this with a few I’ll end this with a few thoughts about what thoughts about what
YOUYOU can docan do
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Cost Containment OptionsCost Containment Options Do NothingDo Nothing Cut BenefitsCut Benefits Pass It OnPass It On Zero In On The DriversZero In On The Drivers
Wellness Council of AmericaWellness Council of America
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
ZERO IN ON THE DRIVERSZERO IN ON THE DRIVERS
What could be done?What could be done?
Billing AuditsBilling Audits
Modify unhealthy lifestylesModify unhealthy lifestyles
Prevent and treat chronic diseasePrevent and treat chronic disease
Temper UtilizationTemper Utilization
Improve Quality of CareImprove Quality of Care
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Improving QualityImproving Quality
PUSH FOR REDUCED PREVENTABLE PUSH FOR REDUCED PREVENTABLE INFECTIONS AND OTHER ERRORSINFECTIONS AND OTHER ERRORS
TALK TO PROVIDERS, ASK TALK TO PROVIDERS, ASK QUESTIONS, CHANGE CONTRACT QUESTIONS, CHANGE CONTRACT STRUCTURESSTRUCTURES
STOP PAYING FOR MEDICAL NEVERSSTOP PAYING FOR MEDICAL NEVERS
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
BY BY ……
USING PHC4 TOOLS!USING PHC4 TOOLS!
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
Special Data RequestsSpecial Data Requests
PHC4 can fulfill customized data requestsPHC4 can fulfill customized data requests You supply the SSNsYou supply the SSNs We aggregate your dataWe aggregate your data NO disclosure of individuals’ infoNO disclosure of individuals’ info There is a fee for this service – reasonableThere is a fee for this service – reasonable Contact Special Requests unitContact Special Requests unit
Pennsylvania Health Care Cost Containment Council (PHC4)Pennsylvania Health Care Cost Containment Council (PHC4)
For more information on For more information on PHC4:PHC4:
225 Market Street, Suite 400225 Market Street, Suite 400
Harrisburg, PA 17101Harrisburg, PA 17101
(717) 232-6787(717) 232-6787
www.phc4.orgwww.phc4.org