First Person
Your Role in Infection Control
Medicare restrictions on payments for hospital-acquired conditions could provide
opportunities for device and diagnostic manufacturers.
Jeffrey Ellis
On October 1, the Center
for Medicare and Medicaid Services (CMS)
implemented restrictions on payments for hospital-acquired infections (HAIs) or hospital-acquired
conditions (HACs). State and private insurance payers for medical
procedures will likely duplicate
these restrictions. CMS is encour-
aging state agencies to follow its
lead when reimbursing hospitals under
Medicaid.
CMS says it does not cover circumstances caused by carelessness.
For example, situations such as leaving sponges or surgical implements in
the patient, using incompatible blood
and blood fractions, or performing the
wrong procedure (or the correct procedure on the wrong body part or on the
wrong patient) are no longer reimbursable. Moreover, surgical-site infections
involving catheters used in treatment
of urinary tract infections, bloodstream
infections, and mediastinitis following
coronary bypass surgery are not covered. Secondary infections following
bariatric obesity treatment, orthopedic
surgery and deep vein thrombosis, and
pulmonary embolism following total
knee and hip replacement are also on
the list of conditions not to be covered.
In addition, there are new requirements for monitoring a patient’s blood
sugar levels to prevent hypoglycemia
and diabetic ketoacidosis. In CMS’s
FY 2010, restrictions on payments
are likely to be extended to outpatient
procedures.
CMS has also considered other conditions for inclusion, such as infections caused by methicillin-resistant
Staphylococcus aureus (MRSA) and
Clostridium difficile,
but has for the time
being held off in anticipation of public
comments.
Hospitals are required to report incidence of HAIs and to
report improvements
in reducing such occurrences, or they
face losing some of their reimbursement. More conditions will be removed
from reimbursement in the future, and
the agency has set April 30, 2009, as
the target date to publish its next list of
nonreimbursable occurrences.
These restrictions should lead to an
increased use of screening procedures
against common HAIs. The goal is to
ensure that conditions predate the patient’s entry to the hospital or treatment
center. Use of diagnostic devices should
increase, and CMS has published a list
of 42 recommended screening procedures. Additional training of hospital
personnel is also required to minimize
the likelihood and incidence of HACs.
The Association of Professionals in Infection Control and Engineering has
instituted conferences and training programs to educate nurses and physicians
in charge of patient safety in the latest
technologies for infection control and
for minimizing HAIs and HACs.
Silver Linings
A benefit to increased use of infection
control procedures is the development
of technologies for disease prevention.
The copper industry has obtained sanction from the Environmental Protection
Agency (EPA) to classify the metal and
some of its alloys as pesticides, thereby
enabling users of these materials to
make claims in their literature about
controlling pathogenic organisms. The
Silver Institute is also considering applying to EPA for a similar designation for
commercial silver-based biocide preparations. For example, needles and other
sharps could be designed with a small
amount of silver in the lubrication coating to make the surface less hospitable
to pathogenic microorganisms.
The increased care taken at hospitals should result in greater comfort
and less harm to patients. It should
also bring down the overall costs of
healthcare. For device and diagnostic
kit manufacturers, the focus must be
on creating products that enable rapid
screening for various medical conditions. Additional opportunities will
arise from products that provide safe
and effective treatment of medical conditions at low cost. Products that are
less hospitable to ambient pathogenic
bacteria, fungi, and other organisms are
in high demand. In addition, products
should monitor and maintain stable
patient temperatures, fluid levels, and
other conditions, such as blood sugar
levels.
Hospital administration and personnel in charge of infection control are
aware of these developments and are
ready to comply with the CMS directives. But companies should inform
customers of products that help them
comply with CMS goals.
The medical device and diagnostic
industry should view these developments as a major opportunity to develop products that can help to deliver
more cost-effective healthcare with
added safety for patients and healthcare personnel. ■
