Get a Clue: C. Diff, other HAI rates will impact reimbursement

Mrs. Peacock, in the Conservatory, with the knife.

The government agencies tasked with interpreting the Affordable Care Act of 2010 are making strides to transform the Act’s colorful plumage into measurable and enforceable metrics. Medicare and Medicaid reimbursements for Long Term Care Facilities and Home Health Agencies will be slashed in the near future; metrics and quality measures replacing the traditional blade. One of the main measurements used to determine cuts will be the frequency of healthcare acquired infections (HAI’s), specifically C. Difficile Infections (CDI’s). Preventing CDI’s is now increasingly important to a facility’s bottom line.

The scope and pervasiveness of HAI’s is also quickly becoming detrimentally transparent. Reporting requirements for acute care hospitals are already in place and they will start paying Medicare take-back penalties in 2015. The days are gone when a whistleblower had the power to bring down a facility for mismanaged infection control. Today, we all operate in glass houses, where a potential customer is only a mouse click away from changing his mind. Preventing CDI’s now impacts a facility’s reputation.

A toolkit for States to eliminate HAI’s and the National Plan to Prevent HAI’s have been published by the Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services (HHS), respectively. Each directive includes an element for Long Term Care facilities, our main customer base. Now, preventing CDI’s is our problem.

In an industry characterized by tight margins and the desire to provide care over the desire to earn a fortune, it’s understandable that the numbers don’t always add up for comprehensive prevention programs. We educate, provide tools and hope for the best, while risking the worst. The Mrs. Peacocks of the world are pushing for additional negative financial pressure in the form of reimbursement cuts, so the time is now to cinch the belt rather than lose the pants. Historically, reimbursement for CDI treatment often falls short of the actual cost, a good motivator for prevention on its own. Further, a CDI outbreak, or any preventable HAI that is allowed to thrive in your facility is a disappointment to the staff that genuinely wants to do the right thing for all the patients. Prevention programs and educating staff to the proper degree are the right steps to eliminating CDI’s in your facility, no matter the motivation.

If reimbursement cuts based on HAI’s, including and especially CDI’s, are a foregone conclusion just over the horizon; what can our customers do to prevent losing some percentage of their reimbursement payments? At Source Diagnostics, we promote a comprehensive prevention program which includes examining previously unnoticed transmission methods, including our presence at your facility. We are acutely aware that our staff and equipment are viable modes of transferring HAI’s between rooms. We take extra steps to prevent CDI’s from spreading. We work with our customers to develop prevention programs and play an important role in educating your staff as well as ours.

Whether Mrs. Peacock, the knife or the Conservatory motivate you; or, like Source Diagnostics, if you believe it’s the right thing for your patients, the time is now to get a clue and start preventing CDI’s in your facility. Please join us in the Parlor for upcoming posts about best practices for CDI and HAI prevention and bring your wrenches; we’re working on solutions!