Pennsylvania Health Care Cost Containment Council (PHC4) Patrick J. Brennan, head of a panel named by the secretary of Health and Human Services years

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


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.


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)


“ “ 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.”


In other words:

You didn’t come in with it, and you got it in the hospital…

How complicated is that?


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 !


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


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


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!


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


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.


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.


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:


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 !!!


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)


Hospital Acquired Infections Hospital Acquired Infections are are NOTNOT inevitable, inevitable, nornor

unavoidable!unavoidable!


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…


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


I’ll end this with a few I’ll end this with a few thoughts about what thoughts about what

YOUYOU can docan do


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


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


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


BY BY ……

USING PHC4 TOOLS!USING PHC4 TOOLS!


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


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

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Pennsylvania Health Care Cost Containment Council (PHC4) Patrick J. Brennan, head of a panel named by the secretary of Health and Human Services years