October means fall leaves, Halloween goblins…and a new “spook” if your local hospital is one that will receive less money from the government. This new Halloween treat will last for a full year however, not just one night. The new healthcare law requires CMS to monitor quality and safety in hospitals and to rank order their results. The legal mandate is to deny payment to hospitals that fall in the bottom quarter of this list. They are designated worst performing and will lose money as a result.
A New Beginning or a Cliff?
The law has mandated pay for performance based on three categories: Readmission Rates, Quality Measures (where hospitals can earn a bonus or be penalized), and the final category, Hospital Acquired Conditions (HAC). HACs will no longer be reimbursed by Medicare beginning this October. It’s no surprise that infections are a big part of this category. Hospitals that fall in the bottom quarter of the list, based on the CMS formula for measuring the pay for performance categories, can ultimately lose up to 5.4% of Medicare payments.
I suggest we ask ourselves what would losing 5.4% of our salary do to our lifestyle?
This aspect of the law raises many issues. One issue of concern is that publically owned hospitals, where many low income patients are treated, are more likely to feel the penalties. Researchers have raised questions about the metrics themselves. Are they accurate enough to address obvious disconnects based on the population of patients treated and other things beyond a hospital’s control? Likewise, if an organization is improving but not enough to pull out of the bottom quarter, how will this financial loss affect patient care?
Pivotal Time for Hospitals
This is a pivotal moment in the history of hospital care for clinicians and administrators. No one can predict what we will look like in two or five years. The complexity of care delivery has stymied many brilliant folks for a long time. The new law has added a layer to that complexity by controlling payments. Our challenges are great.
Sadly, infection rates still have a long way to travel to move closer to Zero. Although there is improvement, it has taken years to make some headway, and many people have suffered as a result. Clinical teams have taken on this problem with creativity and determination. But we need more than that now. We’ve had enough time to address it by ourselves.
Engage Our Patients!
We know the new mantra is patient engagement. Despite the lack of clarity about the meaning of this term it is part of the language today. If you believe that “to engage” implies involvement and a partnership, then let’s consider how we can engage patients in the solution. One of the infection statistics that has dogged us for years is Catheter Associated Urinary Tract Infections (CAUTI).
The research is clear on how we manage this humble ole catheter. We leave them in too long. CDC data show that 30-40% of infections in hospitals come from the urinary catheter. That means about half a million people a year are infected this way and data suggests 13,000 of those folks die as a result.
Last year The British Medical Journal for Quality published a systematic review on the reduction of unnecessary urinary catheter use. When they looked at the findings on interventions to encourage catheter removal by a stop order or a reminder, they found a reduction in the rate of CAUTI by 53%. This is good news, but there is still a gap here.
A Scary Proposal or a Solution?
I propose we cannot do this on our own. It is time to provide patients and families with easy to use tips on how to engage in their own safety. If the stop order or reminder can reduce the rate by half, what do you think we could achieve if the patient/family had a cue card that invited them to partner in stopping this problem? The patient is the last line of defense against this problem, and I believe engaging them in the solutions is a long overdue option.
View Our Team Exercise: Patients & Clinicians Partner to Stop CAUTI
Although your hospital may fall into the last tier and lose money, the real loser is someone’s aunt, friend or dad who becomes infected because of the urinary catheter. In the article we cited earlier, the opening story by a nurse is worth reading as a reminder that CAUTIs do harm and that some people bury a loved one as a result.
Let’s give patients the evidence on use of urinary catheters, and offer them the opportunity to engage with us to stop this problem. Integrating evidence 24/7 is not easy and it takes teamwork. Isn’t it time we bring the most important person into the team efforts? Create a Win-Win solution!