CMS Publishing Bloodstream Infection Rates at Hospitals

The U.S. Department of Health & Human Services (HHS) has started to publish, for the first time ever, data showing how hospitals nationwide compare in their rates of central line-associated bloodstream infections (CLABSIs) in their intensive care units (ICUs). The public can view the rates on HHS’ Hospital Compare website when deciding which facility they want to patronize. The data will be updated quarterly, with rates for other infections added in the future.

Will this be a game-changer? It very well might be. It comes on the heels of other incentives the feds have used to get hospitals to lower their CLABSI rates, so the new effort could create a tipping point. Here are the previous initiatives:

* In October 2008, the federal Center for Medicare and Medicaid Services (CMS) ceased reimbursing hospitals for a number of hospital-associated conditions, including CLABSIs, that it considered preventable.

* CMS lowered the financial boom again about two years later. As we reported here, CMS mandated that to get full Medicare payments, hospitals had to report CLABSIs and certain other healthcare-acquired infections (HAIs) on the CDC’s National Healthcare Safety Network (NHSN).

The reporting to NHSN began in January 2011, and it is that data that is being shared on Hospital Compare. Although the reporting is voluntary, most hospitals participate for obvious reasons – it would be unthinkable to suffer lower Medicare payments. By the way, much of the credit for these government crackdowns goes to Consumers Union, which for years has been pushing for action on HAIs through its Safe Patient Project.

Of course, Hospital Compare is going to keep some hospital CEOs up at night.

Undoubtedly, savvy patients will penalize facilities with high CLABSI rates when they go hospital hunting. Some CEOs complain that a simple comparison of CLABSI rates puts their institutions at an unfair disadvantage. We’re sympathetic to that claim in some cases. We’ve worked with several hospitals whose patient populations are unusually vulnerable to CLABSIs.

For example, we’ve written about one well-regarded children’s hospital that nevertheless has much higher-than-usual CLABSI rates because many of its patients suffer from short bowel syndrome and also receive total parenteral nutrition. Both issues significantly increase CLABSI risk.

But note that this hospital was still able to lower its CLABSI rates dramatically by taking several preventive steps, including implementing an alcohol-dispensing disinfection cap called SwabCap® that improves disinfection of IV connectors. Disclosure: (We represent SwabCap’s maker, Excelsior Medical.)

Numerous hospitals that were struggling to reduce their CLABSIs achieved sharp reductions when they adopted the disinfection cap, which smartly addresses the problems with the traditional approach to disinfecting connectors.

So, yes, Hospital Compare will sometimes compare apples to oranges, but hospitals can and should reduce infections by implementing best practices and evidence-based technologies like the disinfection cap.

Average hospital CLABSI rates have dropped some over the years, thanks in part to campaigns by the feds, Consumers Union, and other concerned organizations. Consider, though, that many experts believe CLABSIs can be completely eliminated. If they’re right, there’s still room for improvement.