Is Hospital Acquired Infections?

Healthcare in the U.S is most expensive than any other developed country. The U.S spends far more on per capita as compared to any other developed. U.S scores low on many outcome measures, inefficiencies and wastes and quality measures as compared to other countries. The Patient Protection and Affordable Care Act is developed to strengthen these failures in the health care system. The U.S healthcare is transforming care from volume based reimbursements to value based payments. The healthcare law works around providing more patient centered care and better preventive care. One of the payment reforms with Obamacare is to penalize the hospitals with high readmission rates for the three conditions – Acute Myocardial Infarction, Heart Failures and Pneumonia.

Medicare is trying to create incentives for hospitals to keep from making patients sicker, instead of healthier, during their inpatient stay. Hospital-acquired conditions (HACs) can lead to poor patient results

Rising medical costs are a worldwide problem, but nowhere are they higher than in the U.S. Although Americans with good health insurance coverage may get the best medical treatment in the world, the health of the average American, as measured by life expectancy and infant mortality, is below the average of other major industrial countries. Inefficiency, fraud and the expense of malpractice suits are often blamed for high U.S. costs, but the major reason is overinvestment in technology and personnel.Health care costs are far higher in the United States than in any other advanced nation, whether measured in total dollars spent, as a percentage of the economy, or on a per capita basis. And health costs here have been rising significantly faster

Implementation of The Affordable Care Act has addressed some issues surrounding HAIs. For instance, section 3008 of ACA recognized the HAC or hospital acquired condition in the Reduction Program to further reduce HACs and improve patient quality. In this program, the ACA seeks to establish a monetary incentive through CMS that will encourage hospitals to reduce HAC or HAIs. Since most not for profit, public, and even large hospitals receive some form of funding through CMS from Medicare or Medicaid payments, this monetary incentive is one of the better incentives to have been recently proposed by the ACA regarding HAIs. Therefore, some of the strategies in managing and developing evidence-based practice relevant in handling

While the United States has some of the best doctors and healthcare facilities in the world we fail at being efficient and effective. Currently there are too many unplanned readmissions, medication errors and hospital acquired infections. The United States health system does not effectively provide preventive medicine for individuals with chronic diseases, and this portion of health care consumers account for the majority of health care costs (Kocher et al., 2010).

In 1998, the United States devoted 13% of its economy to health care, and this figure rose to 16% by 2008. However, despite this rise in government expenditure on health care, outcomes for patients remained the same (Obama, 2016). The quality of the health care system in general was not great; health care

Hospital acquired infections (HAI) will begin to display signs and symptoms within 48 hours. In order to treat the infections, physicians need to diagnostic tools quickly. The manufacturer of new diagnostic test makers, Kalorama Information stated last year that the world demand for testing and treatment of HAI will be over 10 billion dollars by the year 2015, increasing from 9 billion dollars in 2010. Kalorama also stated that HAI has a 5% infection rate of 40 million hospital visits a year, causing 100,000 deaths in the U.S. annually (Kalorama Information, July 14, 2011). Early diagnosis will improve the patient's outcome and decrease the chance of death. According to Kalorama, 20-30% of the HAI can be prevented by the simple use of better hand washing and cross contamination avoidance although the others need more intensive changes such as hospital ventilation systems and using more disposable supplies (Kalorama Information, p. 113) .

These mandates also require that some establishments provide customers with a good outcome and experience while at their facilities. There are also incentives provided to doctors who correctly diagnose their patients for the very first time reducing the rates of readmission this also applied to those that provided outstanding follow up care for patients “The new law provides incentives for physicians to join together to form “Accountable Care Organizations.” These groups allow doctors to better coordinate patient care and improve the quality, help prevent disease and illness and reduce unnecessary hospital admissions. If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save. Effective January 1, 2012” ( HHS>GOV).

Helping patients stay out of hospitals is not only an important quality improvement objective but also a financial one especially after the advent of Affordable Care Act (ACA). Efforts to improve clinical outcomes and reduce readmissions have been ongoing for several years, but still high readmission rates continue to be an issue for most healthcare organizations. Although many hospital readmissions cannot and should not be avoided, a wide variation in readmission rates across the hospitals nationwide, has led the researchers and Center for Medicare and Medicaid Services (CMS) to believe that hospitals can implement various quality improvement strategies to reduce their readmission rates and improve patient care as a whole. In an effort to reduce readmission rates and achieve better quality outcomes, CMS has started Hospital Readmission Reduction Program (HRRP) under which the hospitals will be penalized by up to 3% of total Medicare reimbursements, for readmission cases within 30 days specifically for conditions like heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), and elective hip or knee replacement. The percentage of hospitals receiving a penalty in 2014 was around 64%, which has increased to about 78% in FY 2015 making it a high priority quality improvement concern for healthcare organizations in order to retain their Medicare patients and balance their Medicare reimbursements.

In 2005, in response to disturbing and widely cited findings by the Institute of Medicine about the prevalence of life-threatening conditions acquired by patients in U.S. hospitals, Congress authorized the Centers for Medicare and Medicaid Services (CMS) to implement payment changes designed to encourage the prevention of such conditions. Under an amendment to the Social Security Act that was enacted on January 1, 2007, the secretary of Health and Human Services was required to identify at least two hospital-acquired conditions by October 1, 2007, that were high-cost, high-volume, or both; that resulted in the assignment of a case to a higher-paying diagnosis-related group (DRG) when they were present as a secondary diagnosis; and that could reasonably be prevented through the application of evidence-based guidelines (New England Journal of Medicine, 2009).

Historically, reimbursement has been Fee-For-Service (FFS): tied to volume of visits, hospitalizations, procedures, and tests. This reimbursement structure creates misaligned incentives and fragmented, suboptimal patient care resulting in burgeoning costs and a lack of focus on outcomes. As a result, CMS and the industry have been

(Douglas Scott II, R. March 2009. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Date Retrieved: December 30, 2015, http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf)

With new reforms being put in place under the Affordable Care Act such as the pay-for-performance (P4P) also known as “value-based purchasing,” which is intended to help provide maintain and efficient programs to improve health care cost. Healthcare providers, hospitals, medical groups, and physicians are offered incentives for meeting certain performance goals; it also fines for increased costs and medical errors such as incorrect medication or dosages. In two different studies quality of care was found to have improved at P4P hospitals compared to non-P4P hospitals Lindenauer et al. (2007) and Grossbart (2006). However, a study by Werner et al.(2011) found no continuing benefits in quality of care. One measure being advocated for is the Hospital Readmissions Reduction Program (HRRP) to prevent hospital readmissions as a way to improve the quality of care and at the same time cut cost. If patients are readmitted within 30 days after discharges due to conditions like acute myocardial infarction (AMI), heart failure, and pneumonia, fines can be levied such as 1 percent of Medicare payments. Others include the Hospital Value-Based Purchasing (VBP) is based on how well the hospital performs compared to other hospitals or the improvement of their own performance compared to a baseline time. The goal is to encourage better outcomes for patients and improve experience during hospital stays. And the Hospital-Acquired Condition (HAC) Reduction Program motivates hospitals to increase the safety of it patients by cut the number of hospital-acquired conditions and patient safety (Medicare.gov, n.d.) (Kruse, Polsky, Stuart, & Werner, 2012)(Gu et al.,

The healthcare system in the United States has been somewhat fragmented over the years. This fragmented system has been the cause of threats to patient safety (Leatherman & McCarthy, 2002). The processes used during the period of time prior to the Institute of Medicine report in 1999 were not centralized; this caused differences in patient care between physicians and facilities. In an effort to standardize care protocols and guidelines needed to be put into place. Two specific areas were mentioned in the power point “To Err is Human, The Quality Chasm”. One area that has been a challenge in care is community acquired pneumonia, without a protocol the cost for episode of care was $5211. By putting protocol into place the cost per episode

The political environment surrounding hospitals is far and away the most important key external driver to the industry. Government funded programs, such as Medicare, Medicaid and the Affordable Care Act, have huge effects on the demand to the industry as they determine how many Americans will be insured. The Affordable Care Act is changing the way hospitals function. “The law calls for an emphasis on patient outcomes and overall patient care, which will change how hospitals are reimbursed for services. Under the new law, hospitals with high readmission rates will be reimbursed by Medicare at a lower rate” (First Research, 2014). In essence, hospitals are being punished by not diagnosing and treating a patient correctly the first time. As a result, hospitals must find highly skilled labor and cutting edge machinery to prevent mistakes which in turn