Hospitals Improving on HAIs but Not on Readmission Rates

Hospitals have made significant reductions in the rate of hospital acquired infections (HAI) from central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSI), according to report from the Centers for Disease Control (CDC).  The Robert Wood Johnson Foundation, though, reports that hospitals have made little improvement in the rates of readmission from 2008 to 2010.  HAIs and readmissions to hospitals have become important measures of the quality of care provided to patients in hospitals, and  CMS  has identified both as grounds for a reduction in payment.

HAIs

The CDC reports that in 2011, the number of  CLABSI  was 41 percent lower than expected, and the number of SSIs was 17 percent less than expected. The number of CAUTIs was 7 percent below projections.  The CDC used the data from the National Healthcare safety Network (NHSN) in coming to these conclusions.  Hospitals report HAIs to the NHSN. The data collected by the NHSN is used to determine whether hospitals  qualify for annual payment updates and meet their public reporting requirements.

The number of facilities reporting CLABSI data in 2011 increased to 3,472, up from 2,242 in 2010.The number of facilities reporting CAUTI data increased from 981 in 2010 to 1,807 in 2011. The number of facilities reporting SSI data increased slightly more than 50 percent from 1,388 in 2010 to 2,130 in 2011.  CDC speculates that this increase in reporting is due to hospitals coming into compliance with new CMS reporting requirements that began in 2011 and 2012.

CDC reported that in 2011 there were 18,113 CLABSIs and that modeling had predicted 30,616.  The actual number of CAUTIs reported in 2011 was 14,315 and that modeling predicted 15,398 during this time period.  The number of SSIs was 6,357  during  in 2011, while the modeling predicted 7,682 SSIs. The CDC said that the report indicated that steady progress is occurring towards the goal of a 50 percent reduction in CLABSIs, a 25 percent reduction in SSIs, and  a 25 percent reduction in CAUTIs over the course of a five-year period.  The data reported in this study was from 2011, the third year of the five-year period.  The cost to Medicare for caring for these HAIs in 2011 was estimated by the CDC to be $322 million.

Readmissions

The Robert Wood Johnson Foundation analyzed readmission data from the Dartmouth Atlas Project and CMS, and researchers determined that readmission rates to hospitals  did not change significantly  from 2008 to 2010.  A readmission is deemed to occur when a patient is released from the hospital and then readmitted within 30 days.  It does not matter if the patient is readmitted for a new condition, the treatment of a related condition, or because of the original condition.

The readmission rate for patients who  had surgery was 12.7 percent in 2008 and 12.4 percent in 2010, according to the Robert Wood Johnson Foundation.  For patients who were treated for congestive heart failure, the readmission rate was 21.4 percent in 2008 and 21.1 percent in 2010.  For patients who were treated for a heart attack the readmission rate was 18.7 percent in 2008 and 18.1 percent in 2010.  Finally, for patients treated for pneumonia in 2008, 15.3 percent were readmitted within 30 days and the percentage was exactly the same 15.3 percent in 2010. Previous research estimated that one out five patients admitted to a hospital is readmitted within 30 days.

CMS estimates that $26 billion is spent on readmissions annually and that $17 billion of that amount could be avoided if patients received the right care after discharge. The study found that the majority of these readmission are caused by inadequate discharge planning, poor care coordination, and the lack of effective longitudinal community-based care.

The Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) began penalizing hospitals by reducing their reimbursements beginning in October 2012 if their readmission rate was above a certain threshold.  So far more than 2,000 hospitals have seen reductions in reimbursement because their readmission rates for pneumonia, congestive heart failure, or heart attack patients were too high.  A one percent reduction, the maximum, was applied to 307 hospitals on October 1, 2012; the remainder of the 2,000 hospitals received less severe reductions.  The maximum penalties increase to 2 percent in 2013 and 3 percent in 2014.