Medicare fails to track costly hospital infections

Editor's note: This article has been updated to clarify a statement that implied sepsis is not among the hospital-acquired conditions tracked through CMS; this was inaccurate. We regret the error.

Medicare does not track several expensive, frequently occurring hospital complications, according to a new analysis by Premier, Inc.

The Charlotte, North Carolina-based group purchasing cooperative analyzed more than 5 million hospital records and identified 86 common hospital-acquired conditions (HACs) that correlated with higher costs, longer lengths of stay or patient deaths, including in-hospital heart attacks, acute kidney failure and sepsis.

"Although the CMS HACs are important events to prevent, an exclusive focus on these conditions will miss opportunities to identify and improve care processes for other complications whose elimination could substantially lower mortality, length of stay and costs," the analysis states. "Moreover, such a narrow list of measures fails to provide a complete picture of the quality of patient care in a particular hospital."

The analysis suggests hospitals could identify non-Medicare complications and improve preventive efforts by:

  • Expanding hospitals' ability to "identify, and then address, care processes that may lead to or contribute to complications"

  • Analyzing which hospitals do and don't do well on a broader range of quality measures, "while reducing the arbitrary nature inherent in narrow measures"

  • Helping hospitals analyze the impact of specific complications on measures like length of stay and cost

However, the data is not clear on how many of the additional conditions are preventable, according to the analysis. For example, Premier identified more than140,000 acute kidney failure patients. Although it's possible that some of those cases may be due to the patient receiving the wrong type or amount of drug, they could also be caused by severe pneumonia, Richard Bankowitz, M.D., Premier's chief medical officer, told Kaiser Health News.

"We don't know how many of them are preventable, but we think some of them might be prevented if we used evidence-based protocols," Bankowitz said. "What we're saying to our providers is here is a list of things that happen fairly often and have great consequences when they do occur."

To learn more:
- here's the analysis (.pdf)
- read the Kaiser Health News article