First State Report on Hospital-Acquired Infections Released in Pennsylvania; Cost, Quality Issues Raise Grave Concerns

HARRISBURG, Pa. -- In the first report of its kind, Pennsylvania hospitals reported 11,668 confirmed hospital-acquired infections in 2004, according to a Research Brief titled "Hospital-acquired Infections in Pennsylvania" released today by the Pennsylvania Health Care Cost Containment Council (PHC4).  The hospital admissions in which these infections occurred were associated with 1,793 deaths, and an estimated 205,000 extra hospital days and $2 billion in additional hospital charges.  These numbers are out of

a total of 1.5 million discharges from 173 general acute-care hospitals. 

"This seminal report demonstrates without question that the cost and

quality implications of potentially preventable hospital infections are

astounding," stated Marc P. Volavka, executive director of PHC4.  "This first

snapshot of statewide numbers should be a wake up call for all parties

involved in the delivery and payment of hospital care."

Pennsylvania is the first state in the nation to begin collecting and

reporting information about hospital-acquired infections.  Beginning in 2004,

hospitals were required to start submitting data on four types of hospital-

acquired infections to PHC4: three surgical site infection categories; and

Foley catheter-associated urinary tract infections, ventilator-associated

pneumonia and central line-associated bloodstream infections.  As of

Jan. 1, 2006 hospitals will be required to submit data on all hospital-

acquired infections to PHC4.

During this process, PHC4 has expressed its concern regarding the wide

variation in reporting levels among hospitals in the state.  "As we started

down this uncharted path, we said from the beginning that it would take time

for Pennsylvania's hospitals to become accustomed to this reporting process,

and the Council continually worked with individual hospitals and the Hospital

& Healthsystem Association of PA (HAP) to provide lenient timeframes and

extensions to hospitals having difficulty," said Volavka.

However, 29 hospitals (17 percent), which account for 25 percent of all statewide

admissions, reported more than half (50.6 percent) of the 11,668 hospital-acquired

infections.  Several large hospitals submitted invalid infection data for the

majority of their discharges.  Sixteen hospitals, including several large

hospitals, reported no infections at all.

"The Council is continuing to work with HAP, and these hospitals, to

encourage full compliance, and we believe overall that they are making a good

faith effort.  However, results from the first full year of data collection

indicate that while some hospitals worked very hard to meet the hospital-

acquired infection data collection requirements, other hospitals provided only

minimal information," said Volavka.  He noted there was a steady increase

each quarter of 2004 in the number of hospital-acquired infections reported;

yet, submission disparities among hospitals raised some concerns regarding the

accuracy and completeness of the reported data.

"While we recognize and applaud the Pennsylvania hospital community for

their significant participation in several new patient safety initiatives,

including the Institute for Healthcare Improvement's 100,000 Lives Campaign

(http://www.ihi.org/ihi), and the surgical infection prevention project with

Quality Insights of Pennsylvania (QIP), the cost and quality implications of

hospital-acquired infections cry out for continued focus and more resources,"

said Volavka.

One of PHC4's major interests is the discrepancy between the number of

hospital-acquired infections reported by hospitals (11,668) and the 115,631

infections billed to purchasers, private insurers and government programs like

Medicare and the state's Medical Assistance program.  PHC4 screened the 2004

billing data for diagnoses that may possibly indicate the presence of a

hospital-acquired infection.  While it is reasonable to assume that not all

these infections are acquired in the hospital, these billed infections suggest

the possibility of more hospital-acquired infections than those confirmed by

hospitals and reported to PHC4.

There has been no release of data on a hospital-by-hospital basis, he

said, because this could penalize hospitals that have more fully and

completely reported their data to PHC4.  "We made a commitment to our hospital

community that we would NOT release hospital specific data until we could

reasonably assure ALL hospitals that we were comfortable with the accuracy and

completeness of the reporting," said Volavka.

PHC4, also for the first time, was able to look at actual payment data for

these occurrences.  Previously, all cost assumptions were based on hospital

charges, which are not what hospitals are actually paid in heavily discounted

arrangements with insurance companies.  The newly submitted payment data from

third party payors shows that in 2003, the average payment for the treatment

of a patient with an infection was more than $29,000, compared to an average

payment of $8,300 for a patient without an infection.

"Those who pay for healthcare in Pennsylvania are

paying four times as much for potentially preventable infections occurring

every day in our hospitals," said Volavka.

Assuming payments remained static between 2003 and 2004, PHC4 estimates

that third party insurance payments (distinct from hospital charges) for just

the 11,668 reported infections were nearly $350 million annually.  "Quality

improvement efforts must be redoubled, and hospital Boards and CEOs, along

with those paying the bills, must insure that infection control departments

and their dedicated staff get the support and resources they need to reduce

infections to the most minimally acceptable level.  The quality case is

imperative, the business case is compelling," Volavka added.

The Pennsylvania Health Care Cost Containment Council is an independent

state agency charged with collecting, analyzing and reporting information that

can be used to make more informed decisions, thereby improving the quality and

restraining the cost of health care in Pennsylvania. 

Source: Pennsylvania Health Care Cost Containment Council