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Healthcare Reform Impact/Role of IP

Q. What role does infection prevention play in healthcare reform? What kind of impact can infection prevention have on the bottom line?   

A. The healthcare system has undergone significant changes. The “volume-to-value" shift is influencing the way hospital systems operate and was designed to achieve The Triple Aim set forth by the Institute for Healthcare Improvement (IHI) -- reduction of total population cost, improvements in quality and improvements in patient experience.[1]

Included are changes to reimbursement rates. The Hospital Value-Based Purchasing Program (VBP) designed by the Centers for Medicare and Medicaid Services (CMS) rewards acute-care hospitals with incentive payments for the quality of care they provide to people with Medicare. For instance, hospital-acquired conditions are penalized (1% penalty top quartile), as are readmissions.[2] For an average 300 bed hospital, $6-7 million could be at risk for performance across VBP measures.  

Infection prevention can have an impact on all three objectives of the Triple Aim. It’s been shown healthcare-associated infections (HAIs) are associated with prolonged length of stay and cost per patient.[3] Infection prevention initiatives, therefore, can help mitigate these costs and quality risks.  In addition, these programs can potentially impact patient perception regarding the “Cleanliness of Hospital Environment” measure in HCAHP surveys.[4]

Moving forward it will be increasingly important to demonstrate how infection prevention and control initiative affects the budget and overall strategic goals of a facility. Administrators will be interested in cost versus savings and measureable value of the program.

[1]  Institute for Healthcare Improvement. Triple Aim. Accessed November 22, 2013.

[2] Centers for Medicare and Medicaid Services. FY 2013 Program: Frequently Asked Questions about Hospital Updated March 9, 2012. Accessed November 22, 2013.

[3] Lucado et al. Adult Hospital Stays with Infections Due to Medical Care, 2007. Healthcare Cost and Utilization Project. Agency for Healthcare Research and Quality. August 2010. Accessed November 26, 2013.

[4] Centers for Medicare and Medicaid Services. HCAHPS: Patients' Perspectives of Care Survey. www.cms.govAccessed November 26, 2013.