During the 2009 KY General Session, HB 67 was Submitted by Representative Henley for mandatory public reporting of Hospital or Health Care Acquired Infections and MRSA surveillance cultures.

Background of MRSA and HAI (Adapted and updated  from Preamble of SB 183): 

• Each year 2,000,000 patients in the nations become infected after entering a health care facility. 100,000 die as a result of those infections.
   
• CDC estimates that one in 20 patients entering a health care facility carries MRSA.
   
  
• Routine screening for MRSA in Denmark and Holland reduced MRSA infection rate of 10%.  A pilot program by the VA Hospital System reduced MRSA infection rate by 70%.  And Northwestern University found a large reduction in MRSA infections during admissions and 30 days after discharge.   View Article
   
  
• The CDC reports that the number of cases of health care acquire infection exceeds the number of cases of any other reportable disease, and more deaths are associated with health facility-acquire infection than several of the top ten leading causes of death reported in the United States.
    
• The nationwide cost of treating patients with health care acquire infections is estimated to be almost 5 billion dollars.
  

GAO Report Sept 2008 - Health Care Acquired Infections in Hospitals.   http://www.healthwatchusa.org/downloads/20081003-GAO-Report-d08808.pdf 

"...also include the development and promulgation of procedures and definitions that enable ICPs to determine in a systematic and consistent way which have HAIs and to measure their HAI rates overtime. In addition, CDC has initiated and maintained data collection programs, such as NHSN, that provide a mechanism that compare their experience with that of other hospitals using the same set of clinical definitions and data collection procedures.
(NHSN) is also available at no cost to the hospitals that use it."

Why is Mandatory Reporting Needed?

The Joint Commission's latest report shows only 113 sentinel events were voluntarily reported over a 13-year period (1995-2008).  The Joint Commission. Sentinel Event Statistics - December 31, 2008. Retrieved January 1, 2009, From http://www.jointcommission.org/SentinelEvents/Statistics/ 

In the 4.5 years of Connecticut’s voluntary, confidential adverse event reporting, hospitals have reported only 14 hospital-acquired infections. Connecticut Department of Public Health. (2008). Health Care Quality Reports, Adverse Events. Legislative Report To the General Assembly. Retrieved January 30, 2009, From  http://www.ct.gov/dph/cwp/view.asp?a=3132&q=388090 

US DHHS Action Plan:    The US Dept of Health and Human Services has release a draft action plan to prevent healthcare-associated infections.  http://www.hhs.gov/ophs/initiatives/hai/draft-hai-plan-01062009.pdf  Several interesting statements are contained in this report:

"Another approach CMS has adopted as it transforms the Medicare program from a passive payer towards the goal of being an active purchaser of higher quality, more efficient health care is hospital pay-for-reporting."

"Public reporting enhances accountability in healthcare by increasing the transparency of quality data.  Public reporting is designed to create both "indirect" financial and non-financial incentives to improve quality of care.  Indirect financial incentives result when pubic reporting drives patients' choices and, therefore, market share.  Non-financial incentives include publicizing performance, reputations, competition, motivation, accountability, and public, recognition."

SHEA/APIC Position Statement:   http://premierinc.com/quality-safety/tools-services/safety/topics/guidelines/downloads/01-shea-apic-07-pp.pdf 

"Although there is considerable evidence supporting the use of active surveillance cultures as a clinically effective and cost-effective method for combating the spread of antimicrobial resistant microorganisms in specific circumstances, to mandate as a SINGLE INFECTION CONTROL INTERVENTION applied to all circumstances would preclude local risk assessment and the implementation of a broad range of interventions needed to control infections..."

Health Watch USA does not support surveillance cultures to be USED AS THE SINGLE CONTROL INTERVENTION !!!

Cost Analysis of Mandatory Public Reporting of Health Care (Hospital) Acquired Infections and MRSA Surveillance Cultures:

House Bill 67 has been submitted.  This bill is very similar to the one submitted by Senator McGaha in 2008.  The cost analysis seems to have stalled the bill.   Cost estimates by the LRC from data provided from the Cabinet of Health and Human Services estimate the cost at $2,300,000 per year.  This includes $300,000 for two epidemiologists and $100 per screening test for 20,000 tests on 10,000 Patients.  http://www.lrc.ky.gov/record/09RS/HB67/fn.doc 

Health Watch USA feels these costs are greatly overstated and that this bill should save Medicaid significant funds for the following reasons:

#1.  The CDC has developed and implemented a standardize methodology and reporting system (NHSN) which is free for hospitals to use .  http://www.healthwatchusa.org/downloads/20081003-GAO-Report-d08808.pdf 

#2.  It should not take two epidemiologists to run the program, one is ample.

#3.  The cost of the screening test is substantially overestimated.  The Nov. 16, 2008 KY Senate testimony addressed this issue.  http://www.healthwatchusa.org/mrsa/mrsa_presentations.html   The following testimony was given:

A).  Senator Dick Roeding stated an MRSA test (culture) costs $10.00 per test.

B).  Dr Marty Evans, infectious disease medical  director at the Lexington VA Hospital and a Kentucky Hospital Association witness, stated that the MRSA PCR test cost $30 per test.  The PCR test gives results in hours and is the gold standard.  (Types of Screening tests for MRSA  http://www.questdiagnostics.com/brand/business/files/mrsa_pcr.pdf).

C).  Senator McGaha testified that “many hospitals” are already doing this and in these facilities there is no increase in cost.

MRSA PCR tests could be used for unplanned hospital admissions and MRSA Culture for planned hospital admissions and discharges. 

Health Watch USA thus estimates the cost at $200,000 for personnel and $400,000 for testing.  For a total of $600,000 per year.  In addition, the increase in cost of a hospital acquired infections has been reported by the State of Oregon to be $32,000 per infection.   Thus, the breakeven point is the prevention of approximately 20 of these infections per year.  http://www.oregon.gov/OHPPR/RSCH/docs/HAI111406.pdf  

The increase in cost to commercial insurance in Pennsylvania for each Health Care Acquired Infection is over $52,000.   http://www.allhealth.org/BriefingMaterials/HospitalacquiredinfectionsonPennsylvania-98.pdf