PHC4 CABG Report

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• February 1, 2005

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 while not
taking a position on mandatory public reporting
of infection rates said There is no evidence
to support public disclosure as a means to reduce
the incidence of these infections. Letter to
the Editor - Marc P. Volavka, Executive Director,
PHC4 Unfortunately, Dr. Brennan was only half
right. There is no evidence to support public
disclosure because public disclosure of
hospital-acquired infection has never occurred.
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Hospital-acquired Infections

• In January 2004 PHC4 became one of the first
  state agencies in the nation to collect hospital
  data on infections contracted by patients while
  in the hospital.

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• Using the same definition as CDCs National
  Nosocomial Infections Surveillance System (NNIS)

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A localized or systemic condition 1) that
results from adverse reaction to the presence of
an infectious agent(s) or its toxin(s), and 2)
that was not present or incubating at the time of
admission to the hospital.
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In other words You didnt come in with it, and
you got it in the hospital How complicated is
that?
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• PHC4 formed a Hospital-acquired Infection
  Advisory Panel to help design data collection
  processes.
• This expert advisory panel included infection
  control professionals, physicians, medical
  records specialists and quality assurance
  representatives.
• And, we started to get results !

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Reporting Requirements - 2004

• Surgical site infections for orthopedic surgery,
  neurosurgery, and surgery related to the
  circulatory system
• All device-related infections for
• certain urinary tract infections
• Ventilator-associated pneumonia
• Central line-associated bloodstream infection

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Hospital Acquired Infections in Pennsylvania
Facilities during 2004

• 11,668 patients were confirmed by PA hospitals as
  having 4 types of HAI ... tip of iceberg
• 1,793 died 5 Pennsylvanians every day!
• 205,000 extra days in the hospital
• 2 BILLION in additional hospital billing that
  was sent to someone to pay

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Same report (using 2005 data)

• 19,100 REPORTED HAIs
• 12.2 per 1,000 cases
• 3.5 BILLION charges in PA
• 394,000 hospital days!

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March 2006 more research

• New infections data showed more than 600 million
  in ACTUAL PAYMENTS!
• First-of-its-kind data in USA

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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.
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After almost three years of data collection
and reporting PHC4 released the first
hospital-specific report on Hospital-acquired
Infections in Pennsylvania on November 14, 2006.

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HAI Key Findings
19,154 cases reported 12.2/1,000 cases 394,129
hospital days 3.5 billion in hospital charges

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DOES PUBLIC REPORTING WORK?

• YES ! and it creates
• SAVINGS OPPORTUNITIES!

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Now, as riveting as these numbers are for the
person paying the tab heres an equally
compelling business case for a hospital CEO

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CCU/MICU and HAIA Big Return on Investment

• Savings (1 hospital, 1 calendar yr)
• CLAB 1,235,765
• VAP 1,003,162
• TOTAL HAI elimination initiatives 2.2M
• Investment 35,000
• ROI 631 !!!

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Hospital Investment Needed

• Dedication to process improvement
• Install automated system of measurement (Medmined
  or other)
• Measure infections! (you cannot improve what you
  do not account for and measure)

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Hospital Acquired Infections are NOT inevitable,
nor unavoidable!
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They are about broken processes of careand,
there are Hospitals, all across this country,
that are beginning to demonstrate that HAIs CAN
be reduced or eliminated
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Peer-Reviewed Medical Journal

• Three NEW articles on HAIs, Nov/Dec 06
• Substantive medical evidence
• Not reliant on patient case mix
• Not age-associated
• Not associated with risk factors upon admission

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WHAT IS LEFT?

• PROCESSES OF CARE

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Ill end this with a few thoughts about what YOU
can do
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Cost Containment Options

• Do Nothing
• Cut Benefits
• Pass It On
• Zero In On The Drivers
• Wellness Council of America

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ZERO IN ON THE DRIVERS
What could be done? Billing Audits Modify
unhealthy lifestyles Prevent and treat chronic
disease Temper Utilization Improve Quality of Care
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Improving Quality

• PUSH FOR REDUCED PREVENTABLE INFECTIONS AND OTHER
  ERRORS
• TALK TO PROVIDERS, ASK QUESTIONS, CHANGE CONTRACT
  STRUCTURES
• STOP PAYING FOR MEDICAL NEVERS

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• BY
• USING PHC4 TOOLS!

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Special Data Requests

• PHC4 can fulfill customized data requests
• You supply the SSNs
• We aggregate your data
• NO disclosure of individuals info
• There is a fee for this service reasonable
• Contact Special Requests unit

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For more information on PHC4

• 225 Market Street, Suite 400
• Harrisburg, PA 17101
• [phone]
• www.phc4.org