Florida Hospitals Payments Penalized for Hospital-Acquired Conditions

Hospitals have been closely scrutinized as part of the Affordable Care Act (ACA), which includes the Hospital-Acquired Condition (HAC) Reduction Program.

Beginning in fiscal year 2015, the program directed by the Centers for Medicare & Medicaid Services (CMS) reduces hospital payments by 1 percent for facilities that rank amongst the lowest performing 25 percent with respect to specific HACs.

The program's specific patient safety measures concern the following healthcare-associated infections (HAIs):

• Central line-associated bloodstream infections (CLABSI);
• Catheter-associated urinary tract infections (CAUTI);
• Surgical site infections (colon surgeries and abdominal hysterectomies) (2016 addition);
• Methicillin-resistant Staphylococcus aureus (MRSA) (2017 addition); and
• Clostridium difficile infection (CDI) (2017 addition).

According to a Miami Herald report, 758 hospitals nationwide will be subjected to a 1 percent reduction in their Medicare payments for the federal fiscal year that runs through September 2016 (in fiscal year 2015, 724 hospitals were subject to a payment reduction). This includes seven South Florida hospitals.

While the goal of this program, including the reduction of payments, is to create improvement in patient safety and quality, hospitals that treat the sickest and therefore the riskiest patients will be penalized as an unintended consequence. The public needs to be cautious when interpreting the information while bearing in mind that hospitals are making the effort to reduce HAIs and progress occurs over time.

It is imperative for hospitals to remain vigilant in their efforts to prevent and reduce HACs and HAIs. These efforts should include use of an infection prevention risk assessment, conducting ongoing infection control education and always following proper safety guidelines and recommendations.

 

Phenelle Segal
Dec 21, 2015

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Consumer Reports Investigation Reveals Florida Hospitals Excel, Struggle at Preventing Acquired Infections

Consumer Reports has announced it is factoring in two new acquired infections in its hospital ratings, and Florida residents will want to pay attention to what the data reveals.

The ratings of more than 3,000 U.S. hospitals now includes information on methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. diff) infections. To develop ratings for MRSA and C. diff, Consumer Reports indicated it analyzed infections data submitted by the hospitals to the Centers for Disease Control and Prevention (CDC).

The MRSA and C. diff Ratings are now part of Consumer Reports' ratings, which also include central-line associated blood stream infections, surgical-site infections and catheter-associated urinary tract infections. Consumer Reports indicated that these scores, along with the new data for MRSA and C. diff, make up a larger composite infection score for individual hospitals.

To earn Consumer Reports' very top rating in preventing MRSA or C. diff, a hospital had to report zero infections. Just 322 hospitals in the U.S. were able to achieve that level in the MRSA ratings, and 357 accomplished it for the C. diff ratings. Just 105 succeeded in earning high ratings against both infections.

Only nine hospitals received higher ratings in avoiding not only MRSA and C. diff infections but also for avoiding the other infections included in Consumer Reports' ratings. Florida was represented by Jupiter Medical Center.

Unfortunately, Florida was also identified as the home of three of the 12 hospitals that earned lower scores for avoiding all five infections: St. Petersburg General Hospital, UF Health Jacksonville and Venice Regional Bayfront Health.

In a statement provided by St. Petersburg General Hospital to the Tampa Bay Times, a hospital spokeswoman noted that St. Petersburg General had met the federal government's national benchmark for MRSA and C. diff infections as reported on the Medicare website. "This is in addition to being recognized as a top performer on key quality measures by the Joint Commission," the spokeswoman said.

When contacted by The Florida Times-Union to respond to the Consumer Reports ratings, UF Health Jacksonville officials referred the publication to a May 21 letter (pdf) sent by UF Health Jacksonville CEO Russell Armistead to Gov. Rick Scott that spoke to the reasons for an increase in hospital-acquired infections and efforts the hospital was taking to reduce them.

Meanwhile, Venice Regional Bayfront Health was in the spotlight not for the Consumer Reports ratings but news that its CEO was resigning, according to a Herald Tribune report. He resigns as the hospital is dealing with the results of a joint state and federal investigation into the hospital's clean-up after a large scale sewage leak in May. The investigation reportedly revealed that the hospital failed to properly clean up the sewage, putting patients at risk of infection, and failed to address a rat infestation. The hospital now faces the potential loss of its Medicare certification.

Read the full Consumer Reports article on its new ratings by clicking here and see Consumer Reports' most complete and current ratings for more than 3,000 U.S hospitals by clicking here.

If your hospital requires assistance with reducing healthcare-associated infections, contact Infection Control Consulting Services (ICCS). For more than 30 years, ICCS, based in Delray Beach, Fla., has provided infection prevention consulting services to healthcare organizations in Florida and throughout the country. Services include development of customized infection prevention and infection control programs; mentoring and onboarding of novice infection preventionists; assistance with complying with state, federal and accreditation regulations and standards; preparation of corrective plans of action related to survey deficiencies; and much more.

Phenelle Segal
Jul 30, 2015

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Florida Hospital Association Reports Infection Prevention Improvement Statewide

Hospitals nationwide have been intricately involved in quality assurance performance improvement efforts (QAPI) for several years. In 2012, seventy-seven Florida hospitals, under the direction of the Florida Hospital Association (FHA), enrolled in the largest hospital quality improvement project in the state in partnership with the American Hospital Association, Centers for Medicare and Medicaid Services (CMS) and the Hospital Engagement Network (HEN). They set a goal of achieving a 40% reduction in harm and a 20% reduction in preventable readmissions within a three-year period.

The project was extensive, with hospitals working through the FHA HEN providing many resources to fulfill the requirements. The focus was placed on 11 major areas that are notoriously for having the highest reported incidences of preventable harm. Four of these areas related to healthcare-acquired infections (HAIs), including central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), surgical site infection (SSI) and ventilator-associated pneumonia (VAP).

According to a recent FHA report (pdf), results on this initiative are very encouraging thus far, and include significant improvement in reduction of HAIs. Within the 11 areas of focus, it was reported that 27,500 cases of harm were prevented. The overall harm rate was reduced by 54% and an estimated $170 million in healthcare costs were avoided.

Of note in the report is a special mention of CLABSI and CAUTI reduction: “In addition to the 11 targets, FHA HEN hospitals also worked on reducing dangerous infections such as Clostridium difficile (C. diff), Methicillin-resistant Staphylococcus Aureus (MRSA), sepsis and several other complications."

With Florida's progress toward infection prevention and eliminating patient harm, including HAIs, the state is continuing collaborative efforts as there remains much work needed to continue progress in the area of patient safety. HEN 2.0 will be launching later in 2015, with Florida hospitals striving for the ultimate goal of "safest in the country."

Phenelle Segal
Mar 19, 2015

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Healthcare-Associated Infections in Breast Implant Patients

Healthcare-associated surgical site infections in patients undergoing breast implant surgery have been documented at an increasing rate and are identified more often in patients undergoing construction versus augmentation. Infections have become the leading cause of postoperative morbidity in this population.

When working up a post-operative surgical site infection in breast implant patients, it is important to note the patient's medical or surgical condition. For example, patients who are undergoing mastectomy and radiation therapy for cancer will run a higher risk of infection than a healthy woman who is undergoing augmentation.

Operating room procedures and surgical technique are important to review as well. The origin of infection in women with breast implants can be complex, and may require the expertise of a clinical infection prevention specialist who can assist with an investigation and determine the nature of the infection and possible causes.

Of note in recent years is the emergence of an important group of opportunistic pathogens known as nontuberculous mycobacteria or NTM. They grow rapidly and are often thought to be a cause of infection in breast implant patients.

Phenelle Segal, RN, CIC, President of Infection Control Consulting Services, recently began consulting in Florida and has been hired by several office-based surgery practices as well as ambulatory surgery centers (ASCs) to assist with outbreaks or clusters of NTM. Breast implant infections related to mycobacterium fortuitum, abscessus and chelonae have been the predominant cases she has investigated. NTM is challenging and requires a specific workup for the potential causes. Plastic surgery practices, particularly those located in South Florida due to the heavy concentration of breast reconstruction and cosmetic services in the area, need to recognize the importance of vigilant infection prevention and control practices.

Phenelle has encountered patient infections with various bacterial offending organisms in other plastic surgery procedures in Florida besides breast implants. These include, but are not limited to, Brazilian Butt Lift infections and abdominoplasty infections. Staphylococcus aureus, MRSA and coagulase negative Staphylococcus surgical site infections have also been reviewed in the plastic surgery setting. On-site observation of the environment as well as specific clinical practices is imperative in order to mitigate the risk of infection.

Phenelle Segal
Nov 17, 2014

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