Hospital Infection and Profit

No, this is not the name of a new microbiology journal. Instead, it is one reason why hospital-acquired infections (‘HAI’) in the U.S., compared to many other countries, have not decreased. According to a Clostridium difficile (‘C diff’) expert at the CDC (boldface mine):

“We hear or read all kinds of literature about the cost of an HAI or the cost of an adverse patient event, but what you don’t read very much about – because there is very little data on it – is what are a hospital’s margins on an adverse event,” he said. “Hospital margins are not at all clear. Most of their costs are what is known as ‘fixed costs’ — you have all of these costs that go on. It is not always clear that hospitals lose money on HAIs. It’s just a fact.”

While essentially suggesting that HAIs are factored in as part of the overall cost of doing business, McDonald added that hospitals may also seek out diagnosis-related groups (DRGs) that reimburse at higher levels — typically for care delivered in intensive care units.

“Sometimes they do [lose money on HAIs] because they are in a market where they could get a much higher reimbursing DRG,” he added. “This is where you will find sometimes that CFOs and CEOs are much more interested in the capacity of your ICU than anything else because you can get another higher-reimbursing DRG into an ICU after a CABG [coronary artery bypass graft] or something like that. This all has to do with why we have surgeons who don’t wash their hands and do whatever else they want, and no one from the central office ever jumps on them. Why? Because they bring in all these highly reimbursed DRGs that have a high positive margin. This is the underbelly — what we really don’t want to talk about.

Basically, the CDC scientist is accusing hospitals of profiting from infection because they get to bill charges for treating infection (these staffers are a fixed cost and are paid regardless of how much disease there actually is). Of course, moving people with difficult-to-treat infectious diseases into the ICU isn’t good for the other patients either–that’s why they’re called infectious diseases. I’m not sure how accurate this is–I work with infectious disease people from several hospitals and I don’t think that’s the mindset. However, these are not for-profit systems either; I don’t have any experience with for-profit systems (especially outside of Massachusetts).

It’s worth noting that the UK has managed to beat back C. difficile infections (TEH SOCIALISMZ!!! AAAIIIEEEE!!!). Just worth noting.

I don’t think a CDC expert would deliver a fucking full-frontal body block like this without some sort of high-level approval. Couple this with the use of “nightmare” by Frieden to describe carbapenem-resistant enterobacteriaceae (‘CRE’), and maybe the CDC is trying to get serious about this problem. Hopefully, it’s not too late.

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2 Responses to Hospital Infection and Profit

  1. somedude says:

    In this context it’s worth mentioning that the UK used to be good at combatting MRSA before Thatcher, after her cutbacks not so much.

  2. Pingback: Links 4/17/13 | Mike the Mad Biologist

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