The Wisdom and Justice of Not Paying for “Preventable Complications”

Pronovost, Peter J.; Goeschel, Christine A.; Wachter, Robert M.

doi:10.1001/jama.299.18.2197

Cited by 130 publications

(88 citation statements)

References 14 publications

(15 reference statements)

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“…12 They are considered a measure of less-than-optimal health care with consideration of making related healthcare charges nonreimbursable. 3 A critical look at what gets reported as CLABSI and how CLABSI reporting relates to and is affected by the other BSI categories has not been described.…”

Section: Discussionmentioning

confidence: 99%

“…CLABSIs in inpatients are considered healthcare-associated infections that are preventable and must be reported 2 to payors and local, state, and federal agencies, with implications for reimbursement. 3,4 As a result, BSI surveillance in PHO inpatients has disproportionately focused on CLABSIs; the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) surveillance definition of CLABSI is widely used for this purpose. 5 A BSI from an alternate source of infection (other than the central line), defined by the NHSN as "secondary BSI," has not received similar scrutiny.…”

mentioning

confidence: 99%

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A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients

Gaur

Bundy

Werner

et al. 2017

Infect. Control Hosp. Epidemiol.

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objective. To assess the burden of bloodstream infections (BSIs) among pediatric hematology-oncology (PHO) inpatients, to propose a comprehensive, all-BSI tracking approach, and to discuss how such an approach helps better inform within-center and across-center differences in CLABSI rate.design. Prospective cohort study.setting. US multicenter, quality-improvement, BSI prevention network.participants. PHO centers across the United States who agreed to follow a standardized central-line-maintenance care bundle and track all BSI events and central-line days every month.methods. Infections were categorized as CLABSI (stratified by mucosal barrier injury-related, laboratory-confirmed BSI [MBI-LCBI] versus non-MBI-LCBI) and secondary BSI, using National Healthcare Safety Network (NHSN) definitions. Single positive blood cultures (SPBCs) with NHSN defined common commensals were also tracked.results. Between 2013 and 2015, 34 PHO centers reported 1,110 BSIs. Among them, 708 (63.8%) were CLABSIs, 170 (15.3%) were secondary BSIs, and 232 (20.9%) were SPBCs. Most SPBCs (75%) occurred in patients with profound neutropenia; 22% of SPBCs were viridans group streptococci. Among the CLABSIs, 51% were MBI-LCBI. Excluding SPBCs, CLABSI rates were higher (88% vs 77%) and secondary BSI rates were lower (12% vs 23%) after the NHSN updated the definition of secondary BSI (P < .001). Preliminary analyses showed across-center differences in CLABSI versus secondary BSI and between SPBC and CLABSI versus non-CLABSI rates.conclusions. Tracking all BSIs, not just CLABSIs in PHO patients, is a patient-centered, clinically relevant approach that could help better assess across-center and within-center differences in infection rates, including CLABSI. This approach enables informed decision making by healthcare providers, payors, and the public. 2017;38:690-696 Bloodstream infections (BSIs) cause morbidity and mortality and are especially concerning in pediatric hematology-oncology (PHO) patients. 1 Most oncology patients and some hematology patients have a long-term central line that facilitates their treatment, and these devices can be a source of centralline-associated BSI (CLABSI). Other sources of BSI in immunosuppressed PHO patients include disrupted skin or mucosal surfaces, such as the upper or lower gastrointestinal tract, and deep-seated infections. Frequently, an obvious source of BSI cannot be found. CLABSIs in inpatients are considered healthcare-associated infections that are preventable and must be reported 2 to payors and local, state, and federal agencies, with implications for reimbursement. 3,4 As a result, BSI surveillance in PHO inpatients has disproportionately focused on CLABSIs; the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN) surveillance definition of CLABSI is widely used for this purpose. 5 A BSI from an alternate source of infection (other than the central line), defined by the NHSN as "secondary BSI," has not received similar scrutiny. Additionally, the NHSN definitio...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients

Gaur

Bundy

Werner

et al. 2017

Infect. Control Hosp. Epidemiol.

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“…However, the boundaries between AEs and POC events are constantly shifting as we learn more about the biology, prevention and treatment of disease (13).…”

Section: Some Adverse Events (Aes) Evolve From the Course Of Diseasementioning

confidence: 99%

Process of Care Events in Transplantation: Effects on the Cost of Hospitalization

Egorova

Gelijns

Moskowitz

et al. 2010

American Journal of Transplantation

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Deviations in the processes of healthcare delivery that affect patient outcomes are recognized to have an impact on the cost of hospitalization. Whether deviations that do not affect patient outcome affects cost has not been studied. We have analyzed process of care (POC) events that were reported in a large transplantation service (n = 3,012) in 2005, delineating whether or not there was a health consequence of the event and assessing the impact on hospital resource utilization. Propensity score matching was used to adjust for patient differences. The rate of POC events varied by transplanted organ: from 10.8 per 1000 patient days (kidney) to 17.3 (liver). The probability of a POC event increased with severity of illness. The majority (81.5%) of the POC events had no apparent effect on patients' health (63.6% no effect and 17.9% unknown). POC events were associated with longer length of stay (LOS) and higher costs independent of whether there was a patient health impact. Multiple events during the same hospitalization were associated with the highest impact on LOS and cost. POC events in transplantation occur frequently, more often in sicker patients and, although the majority of POC events do not harm the patient, their effect on resource utilization is significant.

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“…5 The incentives for hospitals to neither report the retained foreign body nor its removal are high, and Pronovost et al (2008) have argued that these complications of care may be inconsistently diagnosed between organizations. Within a single admission, however, inconsistent or non-reporting is almost irrelevant from a funding perspective, as it will rarely impact payment (McNair et al, 2009).…”

Section: Readmissions For Hacs Should Always Trigger a Payment Modifimentioning

confidence: 99%

Enhancing Medicare’s Hospital-Acquired Conditions Policy to Encompass Readmissions

McNair

Luft

2012

MMRR

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The Wisdom and Justice of Not Paying for “Preventable Complications”

Cited by 130 publications

References 14 publications

A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients

A Prospective, Holistic, Multicenter Approach to Tracking and Understanding Bloodstream Infections in Pediatric Hematology-Oncology Patients

Process of Care Events in Transplantation: Effects on the Cost of Hospitalization

Enhancing Medicare’s Hospital-Acquired Conditions Policy to Encompass Readmissions

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