The Centers for Medicaid & Medicare Services (CMS) plans to trim Medicare payments in fiscal year 2019 for 800 hospitals who recorded the highest rates of patient injuries and infections.
Under the Hospital Acquired Conditions (HAC) Reduction Program, hospitals are compared to one another on several quality and safety metrics, including infections. Those that rank in the lowest-performing quartile face a 1 percent reimbursement cut.
The federal government began issuing quality-based penalties under the HAC Reduction Program five years ago, as part of the national pay-for-performance strategy to transition the industry to value-based care. The program has required hospitals to not only rethink how they prevent and treat infections, but also to find solutions that can trend individual performance measures and predict penalties, thereby reducing the overall financial impact of declining payments.
One of the performance measures CMS added to the HAC Reduction Program in fiscal year 2019 is the post-operative sepsis rate – an important one, as surgical patients have a higher risk of infection.
The cost of treating hospital-associated sepsis is on the rise
A recent analysis by Premier® found that, while the overall incidence of hospital-associated sepsis is declining, patients who develop sepsis in the hospital are more likely to suffer from septic shock, the most severe form of sepsis. As a result, these cases are consuming greater expenses – the average cost per case for hospital-associated sepsis in October 2018 was $70,000, an increase of 20 percent from 2015. Hospital-associated sepsis also costs about seven times more than the average inpatient stay.
One place to start tackling the rising severity and cost associated with HACs is in the pharmacy.
While drugs can stay on the Food and Drug Administration’s drug shortage list for years and antimicrobial-resistance is on the rise, shrewd providers are not letting these circumstances affect the quality of care delivered. They are aware that adherence to evidence-based care paths leads to care delivery that leads to optimal outcomes while aligning to financial goals.
Four ways to optimize pharmacy operations to treat HACs quickly and effectively
- Employ technology that demonstrates hospital antibiotic resistance patterns.
With antimicrobial resistance showing little signs of slowing down, leaders must work with their experts in infectious disease, infection prevention, pharmacy and supply chain to stay ahead of new antibiotic options that target sepsis-causing bacteria. Information from clinical surveillance solutions should be an integral part of those discussions. Clinical surveillance tools with an antibiogram feature, such as those powered by TheraDoc®, demonstrate a hospital’s antibiotic resistance pattern and which drugs are more likely to resist antibiotics and thus be ineffective for treatment. This is especially pertinent for health systems whose facilities span wide urban and rural geographies. While one drug may work well for patients in rural areas, it may not be appropriate for patients in urban facilities because of different resistance patterns in that region. Effective clinical surveillance solutions can aggregate drug resistance information to inform smart supply chain decisions so that clinicians in individual settings have access to the most appropriate antibiotic for their patients.
- Reduce order-to-needle time by keeping pre-mixed formulations on hand.
Pharmacy companies have approval to make some of the most common strengths of go-to drugs in pre-mixed formulations. These formulations of antibiotics come in multiple dosages and can be stable at room temperature, meaning clinicians can store them within reach and administer them in a timely fashion. This is critical in areas such as the intensive care unit or the operating room. Pre-mixed formulations can also cut down on order-to-needle time, as the pharmacy does not need to mix the drug and deliver it to the point of care.
- Consider a supply chain solution that identifies safe, high-quality supply sources for drugs on the national drug shortage list.
Drug shortages have been on the rise for several years, with an estimated 210 drugs currently at risk or not readily available for U.S. hospitals and heath systems, according to the national database maintained by the American Society of Health System Pharmacists. With wide-ranging effects on patient care, drug shortages can add time and expense as providers manage supplies and search for therapeutic alternatives. While new solutions, such as ProvideGx, are quickly bringing shortage drugs back to the market, a supply chain partner is key to quickly identifying alternatives.
- Monitor drug utilization.
If drug utilization is on leadership’s radar, especially as part of a robust antibiotic stewardship program, clinicians need the ability to target and optimize drug therapy in real time. This can be accomplished through:
- Customizable alerts, created by the clinician within their clinical surveillance technology, to focus on critical patient indicators, such as the appropriate dosage of drugs.
- The creation of surveillance lists to monitor patients against organizational priorities. This can include pulling lists of patients who are on certain drugs that supply chain may be tracking from a spend or usage perspective or evaluating how many patients are on a given drug to understand usage trends.
- Data analysis across all medications to understand trends. This goes hand-in-hand with the creation of surveillance lists. If leaders are monitoring usage of specific drugs, they can pull a medication utilization analysis report from the enabling technology to track which drugs are being over-used, where in the organization they are being used and which providers are prescribing them.
In addition, surveillance technology plays an important role in helping clinical pharmacy teams submit antibiotic utilization and resistance rates to national agencies, such as the Centers for Disease Control, to improve antimicrobial usage nationally.
These steps help inform intervention data that show pharmacists’ responses to indicators in the clinical surveillance solution and target the drugs that are most problematic. Simultaneously, the business intelligence allows leaders to identify areas for targeted clinical improvement to optimize drug utilization.
Look beyond silos at overarching patient outcomes
Pharmacy optimization projects should include the big-picture view of how decisions are affecting patient outcomes. If a product’s use is effective at improving total outcomes and reducing costs over the course of the episode, it’s yielding better value.
For example, if an organization is facing antibiotic resistance to Drug A and must use Drug B to treat a septic patient at twice the cost, leaders should look beyond the supply chain expense and examine the holistic outcome. While more expensive on the surface, Drug B may allow the patient to leave the ICU a day earlier, leading to overall cost savings. A clinically-driven approach that marries cost, quality and supply chain strategies requires education and continuous communication throughout the organization, including across the supply chain, infectious disease partners, pharmacy and hospital administration.
While drug shortages and antibiotic resistance may remain in the headlines, leading organizations know the methods to circumvent these challenges and reduce the incidence of HACs.
Find out what else organizations can do to provide high-quality, cost-effective care to sepsis patients by downloading Margin of Excellence: Lowering the Incidence and Severity of Hospital-Associated Sepsis.