The sticky question of who foots the bill for hospital-acquired infections is at the center of a dust-up in Pennsylvania between an independent state agency and the state's hospital association.
The dispute between the Pennsylvania Health Care Cost Containment Council, also known as PHC4, and the Hospital & Healthsystem Association of Pennsylvania comes amid growing interest by state legislators in trying to limit hospital-acquired infections. As many as 35 states at least attempted to pass laws that require public reporting of hospital-acquired infections rates in 2005, with two states succeeding, according to one healthcare expert.
At issue in Pennsylvania is a PHC4 report detailing which payers cover the cost of treating hospital-acquired infections. The PHC4 report says taxpayers are ultimately responsible for covering 76% of the costs for the $2 billion in extra charges that resulted from the 11,688 hospital-acquired, or nosocomial, infections reported by Pennsylvania's 173 acute-care hospitals last year. The report is based on further analysis of data first released earlier this year (July 18, p. 9).
But the Hospital & Healthsystem Association of Pennsylvania accused the agency of misleading the public over the cost of nosocomial infections by using hospital charge data even though hospitals generally collect only about 30% of these charges.
"They've reached conclusions based on numbers that we believe are not accurate," said Roger Baumgarten, the association's director of media relations. "We fully support reporting and transparency, but if the data is identified in a form that's misleading, it doesn't help regulators, it doesn't help hospitals and it doesn't help patients."
While agreeing that the hospital association has a valid point, another observer hoped the main points of the report--the human and financial cost of preventable infections--don't get lost in the shuffle. "There's a very antagonistic relationship between the two organizations and it's fueled by reports like this which aren't factually sound," said University of Pennsylvania Health System Vice President and Chief Medical Officer P.J. Brennan. "Nobody is paid on the basis of charges--and we don't get paid anywhere near what we charge. ... PHC4 has a very adversarial relationship with the provider community in many areas of the state and, so when data like these are used in this way, we find it disheartening."
Despite the criticism, Brennan still praised the state agency charged with improving the state's healthcare. "Having said all that, I think the PHC4 is doing the right thing by trying to create transparency," he said. "I think providers get on a slippery slope when they say `It's not $2 billion, it's only a quarter billion,' because it's still a lot of money--no matter how you slice it."
PHC4 Executive Director Marc Volavka said critics are misinterpreting the contents of the report. "We never said that charges equal payments," he said. "What the report tells me--and what it should tell all taxpayers--is that we, as taxpayers in this country, are paying huge amounts of money on hospital-acquired infections."
The report tabulated the number of hospital-acquired cases of pneumonia as well as bloodstream, surgical site and urinary tract infections and found that there was a rate of about 7.5 infections per 1,000 admissions. In 2004, these infections resulted in about $1 billion in extra charges to Medicare, $600 million to commercial insurance companies and $370 million to Medicaid, according to the report.
Mortality was about 16% among Medicare and Medicaid patients with nosocomial infections, but was 3.7% and 1.1%, respectively, among other Medicare and Medicaid patients.
"Medicare patients are typically sicker anyway, infection or no infection," Baumgarten said, protesting that the report attributes the extra mortality to infection which may have only been just one factor out of many for the decline of a patient in poor health.
But Lisa McGiffert, manager of a hospital infection project for Consumers Union, publisher of Consumer Reports, said she is tired of hearing that argument-especially after seeing a friend's mother stay longer in the hospital when she acquired an infection while receiving cancer treatment. "It's not longer in the hospital because she has cancer, it's longer in the hospital because she has an infection," McGiffert said, adding that hospitals still have a culture where a certain number of infections is thought to be acceptable, which can help stop effective, but low-level, interventions such as handwashing from being universally practiced. "I think this is a problem within our healthcare system that is solvable."
She also said that the controversy may have a silver lining. Although initially it may create confusion and put doubts in consumers' minds about the reliability of public reporting of hospital-quality data, it also heightens awareness of the issue, McGiffert said.
She said public reporting of hospital infection rates was debated by 35 state legislatures in 2005, with laws being passed in New York and Virginia. Florida, Illinois, Missouri and Pennsylvania have infection-reporting laws already on the books.
The California Legislature passed a bill, but it was vetoed by Gov. Arnold Schwarzenegger who questioned the need for such a program since the Joint Commission on Accreditation of Healthcare Organizations already scrutinizes hospital infection-control efforts.
Volavka agreed that the controversy will probably mean that the issue will get more attention from the public, but he added that the public is already engaged. He said the previous infection report released in July generated an overwhelming positive response. "They all wanted to tell their story and thank us," Volavka said. "They didn't want anyone else to have to go through what they'd gone through."
Brennan also downplayed the controversy, and said that the PHC4, the hospital association and physicians are all in favor of working together on the problem. "I don't think it's news to the industry or the public that these infections are expensive. They're costly in monetary terms; they're costly in human terms."