One of the outcomes of the passage of the Patient Protection and Affordable Care Act (PPACA) has been an increased emphasis on clinical efficacy, safety, and cost benefit. Hospitals and healthcare systems face multiple challenges in their efforts to make real and significant changes to reduce healthcare spending. The healthcare environment will be even more challenging in the future as providers seek to meet quality and safety mandates, avert Medicare payment penalties for higher-than-expected readmission rates, and avoid financial penalties for high rates of nosocomial conditions and never events.
A recent publication highlights the link between healthcare-associated infections (HAIs) and patient readmission after an initial hospital stay. The findings, published in the June 2012 issue of Infection Control and Hospital Epidemiology, suggest that reducing such infections could help reduce readmissions, considered to be a major driver of unnecessary healthcare spending and increased patient morbidity and mortality.
The researchers tracked 136,513 patients admitted to the University of Maryland Medical Center over 8 years (2001-2008). The study reviewed the number of patients readmitted within 1 year after discharge, as well as the number of patients with positive cultures for one of three major HAIs: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), or Clostridium difficile (C. difficile) more than 48 hours after admission, considered a proxy for an HAI.
The researchers identified 4737 patients with positive clinical cultures for MRSA, VRE, or C. difficile after more than 48 hours following hospital admission. These patients were 40% more likely to be readmitted to the hospital within a year and 60% more likely to be readmitted within 30 days than patients with negative or no clinical cultures. This disparity was evident even after controlling for variables, including age, sex, length of hospital stay, and severity of illness.
The link between HAIs and hospital readmissions is not surprising. These data, however, confirm the need for healthcare facilities to establish a clean plan for reducing HAIs and associated readmissions so they will not be penalized in the future.
Why do you think hospital readmissions from HAIs continue to be a problem? What steps is your institution taking to avoid Medicare payment penalties for higher-than-expected readmission rates?