Pennsylvania last week attempted to satisfy the public's hunger for information on hospital-acquired infections, but a large number of hospitals in the state apparently declined to participate.
In a first-of-its-kind report, Pennsylvania hospitals collectively reported 11,668 hospital-acquired infections in 2004, resulting in 1,793 deaths, approximately 205,000 extra hospital days and $2 billion in additional hospital charges. But the Pennsylvania Health Care Cost Containment Council said in a research brief that the reported infections were probably just the tip of the iceberg based on the 115,631 infections that were identified as most likely hospital-acquired in a separate review of billing data.
"We still have huge, huge variation," said Marc Volavka, executive director of the Cost Containment Council. "Some hospitals are being really compliant and some are not. When I have two hospitals similarly situated with the same type of patient population . . . and one reports 300 infections and one reports four, I have to question whether one of those hospitals has fully reported the data."
Only 29 hospitals, representing 17% of the 173 hospitals in the state and 25% of all statewide admissions, reported more than half of the confirmed infections, while 16 hospitals, including several large hospitals, reported no infections, the agency said. For the time being, the council demurred from releasing hospital-specific data, as prescribed by the law, so as not to penalize hospitals that were compliant.
"We are not going to penalize hospitals that are doing an incredibly good job of reporting. They would end up looking bad and the hospitals that are not reporting would end up looking good," Volavka said. "The goal of the council has always been to get data that is accurate and complete. Once we do that, then the goal of the council is to release publicly hospital-specific information."
Pennsylvania hospitals have been required to submit data on four types of hospital-acquired infections since 2004. Volavka said he was not surprised by the poor initial compliance. When the council first began collecting hospital data in 1986, hospitals reported only 1.2 million admissions the first year and 1.8 million the second. The reporting of hospital-acquired infections has steadily increased each quarter and the data for the first quarter of 2005 has gone up again, he said.
The law stipulates a $1,000 a day fine for noncompliance, but rather than using the stick immediately, Volavka said the council is working with the Hospital & Healthsystem Association of Pennsylvania to identify hospitals that are not fully complying.
The hospital association in a news release "reconfirmed the commitment of hospitals to eradicating hospital-acquired infections," but indicated that there were some "questions about certain data analysis" in the council's research brief.
For example, data on average third-party payments failed to distinguish between infection-related costs and costs associated with the patient's entire hospital stay, according to the news release.
Besides the quality case, there is a compelling business case for reducing infections, Volavka said. Payment data from third-party payers showed that in 2003, the average payment for treating a patient with an infection was more than $29,000, compared with an average payment of $8,300 for a patient without one. The council estimated that insurance payments for just the 11,668 reported infections were nearly $350 million.
Characterizing the Pennsylvania report as "groundbreaking," Consumers Union said in a news release that it "reveals unacceptable costs in lives and dollars to healthcare consumers." The council should use every means it has, including audits, to force compliance, the consumers group said.