Monday, February 28, 2011
Maryland is currently the only state that ties payment to hospital performance on dealing with hospital-acquired conditions. The state sets target rates for each reportable condition and payments to hospitals are tied to meeting the state's targets.
In 2008, Maryland's hospitals collectively had approximately 53,000 cases of hospital-acquired conditions out of a total of 800,000 inpatients and these conditions amounted to approximately $500 million in potentially preventable hospital payments. The initiative was put in place in 2009 in an effort to address hospital-acquired conditions and to improve the quality of care for patients.
More info can be found at the Maryland Health Services Cost Review Commission website
Monday, February 21, 2011
The Department of Human and Health Services (HHS) to make a $750 million investment in prevention and public health
Friday, February 18, 2011
1. Select one of the following options for the population to be analyzed:
a. Option 1 – select a number such as 10 patients who acquired a CLABSI
b. Option 2 – select a class of HAIs for the last year (include any case where a payor was billed for any service related to an HAI; do not include a case if the primary cause of admission was for an infection; do include re-admissions for HAI)
2. Identify the actual or estimated reimbursement for each case
3. Identify the total costs associated with the case, based upon activity-based cost accounting, if available
4. Identify the costs attributable to the HAI
5. Calculate the gross margin for the case by subtracting the expenses from the reimbursement
6. Compare the gross margin for the case to the gross margin of similar cases without an HAI, matched for age, principal diagnosis and admission severity
Once the economic costs are known the next step is to build the business case following the steps outlined by Dr. Eli Perencevich:
1. Frame the problem and develop a hypothesis about potential solutions
2. Meet with key administrators
3. Determine the annual cost
4. Determine what costs can be avoided through reduced infection rates
5. Determine the costs associated with the infection of interest at your hospital
6. Calculate the financial impact
7. Include the additional financial or health benefits
8. Make the case for your business case
9. Prospectively collect cost and outcome data once the program is in effect
Link to full article
Wednesday, February 16, 2011
To ward away the winter chill, I attended a lecture by John G. Thomas, Ph.D. at my regional APIC meeting last Friday. Dr. Thomas is a professor of microbiology at West Virginia University and one of the best speakers I have ever heard. He spoke to us about biofilms, not only giving an eye-opening description of what they are and how they work, but also presenting fascinating information about new lab techniques to identify them (think CAT Scans of specimens!).
During his live presentation we were able to see 3-D action shots of how biofilms develop. He also used his hand puppet sidekicks, Biofilm Bradford and Planktonic Phyllis. Brad and Phyllis demonstrated their unique roles in causing and sustaining infections. One process they are involved in is the Ping Pong cycle.
Rather than trying to summarize his presentation, I am giving you direct links to several of Dr. Thomas' web lectures. I can't say they are as entertaining as the live "show", but they give a lot of insight into the important role that biofilms play in the development and maintenance of infections, such as chronic wounds and VAP. (Trust me, you will never think of an endotracheal tube or a dressing the same way again.) One thing I am sure you will appreciate is that Dr. Thomas respects IPs as a vital part of the health care team.
If you have a limited amount of time to devote to these lectures, I suggest that you watch
Putting the Pieces Together: The Link Between Oral Care, Biofilms and
Pneumonia and Defining the Impact of Microbes in Chronic Wounds: A Biofilm Reactor.
Have patience with the information about dental plaque. You will understand how teeth play a role in infection long before they are decayed or missing.
Each item on the list below is a direct link to a web lecture with slides. To access the link, put your cursor over the title. It will change shape to a I. When this happens, right click and select "Open link" in a new window or new tab, whichever you prefer.
The Micro Mini Series
From Dr. Thomas: Welcome to the Micro Mini Series. Below you will find a series of 30 minute lectures on Biofilms and their importance in today's medicine. It is my hope that these lectures will help shed light on what a Biofilm is, and the risk it presents in today's medical environments.