CMS Gets Tough on Infection Reporting

Ushering in the new year in its own way, the Centers for Medicare and Medicaid Services (CMS) has dropped a hammer on hospitals. A new rule requiring hospitals to report certain central line-associated bloodstream infections (CLABSIs) went into effect last month.

Specifically, the rule states that hospitals must now report the number and rate of adult patients in their intensive care units who get CLABSIs — or the hospitals’ Medicare payments will be reduced by two percent.

We first wrote about this rule in our October 27, 2010 post and you can read the rule’s details there. Part of the rule requires the infection data to be publicly reported on the government’s website, That part of the rule will go into effect later this year.

At Dowling & Dennis, we applaud CMS’ report-or-pay approach. In fact, we think they should carry it a little farther. For instance, the rule only concerns patients in ICUs. We think it should apply hospitalwide.

Even at this point, though, we think this national incentive will be a useful supplement to the patchwork of state reporting laws. There are 27 states that make infection reporting mandatory, with two more that require confidential reporting, and three that have voluntary reporting systems. We expect that the CMS rule will push most hospitals across the country to divulge their infection data.

After all, two percent of Medicare payments is real money.

We’ve learned how important the CLABSI issue is because several of our current or former clients — including Excelsior Medical (SwabCap), Johnson & Johnson (Biopatch), RyMed Technologies (InVision-Plus), and Venetec International (StatLock) – produce medical devices shown to reduce CLABSI risk. Much of our effort the past several years has been to promote the use of these safer technologies.

Where these devices have been implemented, CLABSIs have generally gone down – dramatically. CLABSIs still kill 31,000 U.S. patients per year – in part, because hospitals aren’t adopting such devices fast enough, as many infection control experts have testified.

The CMS rule has several things going for it. For one thing, the data that hospitals report to HospitalCompare will be based on objective, CDC-defined criteria. That isn’t always the case with some state reporting requirements, so that when a consumer compares Hospital A’s infection rate to Hospital B’s, they’re actually comparing apples to oranges. The CMS rule should get us close to apples-to-apples comparisons.

Also, many consumers who have to be hospitalized are likely to go to HospitalCompare to find the safest facilities. You would think all institutions will want a presence in that online system – a presence that includes a low CLABSI rate. This is CMS’s hope, and ours.

AVA Conference Highlights CRBSI

We’ve recently returned from the very successful annual meeting of the Association for Vascular Access ( Though many hospitals have reduced the size of their IV teams or eliminated them altogether, it was obvious from last week’s gathering at the gigantic Gaylord conference center in National Harbor, Md. that there is still a substantial cohort of vascular access experts out there, working hard and deeply committed to better patient care.

One of the highlights of the conference for us was doing a focus group with Excelsior Medical, makers of the SwabCap disinfection cap for needleless IV connectors. Excelsior took the time and effort to meet with a small group of nurses to get some qualitative, very informative feedback about the vascular access challenges that nurses face.

Earlier in the month, Excelsior also teamed with AVA to cosponsor a webinar on best methods to disinfect needless connectors. The webinar is archived at

The focus group and other feedback indicate that hospitals and vascular access nurses remain open to new and better means to achieve two goals:

1.) Complying with Joint Commission and similar protocols for cleaning needleless connectors/disinfection caps.

2.) Reducing catheter-related bloodstream infections (CRBSI, also known as a central line associated bloodstream infections or CLABSI).

Watch this space for more about the AVA conference and other new technological developments featured at the conference.