Pa. Study: Hospital-Acquired Infections Cost Insurers Extra $613M

April 3, 2006

Updated figures confirmed by Pennsylvania hospitals show that the patient safety and financial impact of hospital-acquired infections is larger than originally reported, according to a new research brief from the Pennsylvania Health Care Cost Containment Council (PHC4).

During the first nine months of 2005, hospitals identified 13,711 hospital-acquired infections, compared to 11,668 for all 12 months of 2004, reported PHC4 Executive Director Marc P. Volavka.

“The latest data provided by hospitals underscores that the problem of hospital-acquired infections is larger and more costly than originally estimated,” said Volavka. “The increase can be attributed to the fact that Pennsylvania hospitals are getting better at the reporting process and an expansion in surgical site infection data collection requirements.”

The hospital admissions in which the 13,711 hospital-acquired infections occurred during the first nine months of 2005 were associated with an additional 1,456 deaths, 227,000 extra hospital days and $2.3 billion in additional hospital charges. In its new research brief, PHC4 used actual third-party payment data (distinct from hospital charges) provided by commercial insurers to further quantify the financial toll of the 11,668 hospital-acquired infections reported in 2004. Commercial payment data was provided for 1,119 of the hospitalizations associated with these infections. Payment data for 2005 is not yet available.

This data shows that, on average, there was a $52,600 payment difference between hospital admissions with and without a hospital-acquired infection. Whereas the average payment of a hospitalization with a hospital-acquired infection was $60,678, the average payment for a hospitalization without such an infection was $8,078. Based on payments for the 1,119 hospital- acquired infection cases from commercial insurers for 2004, additional total payments from all payors (Commercial, Medicare, and Medicaid) for the hospital-acquired infection cases in 2004 can be estimated at $613.7 million in Pennsylvania. Total additional insurance payments were estimated by assuming that the average payment remained the same across all payor systems for the 11,668 hospital-acquired infections in 2004.

“The actual insurance payments are mammoth,” said Volavka. “Patients who contract a hospital-acquired infection are five times more likely to die and the payment is more than seven times higher. And, these numbers do not even reflect payments to physicians that care for the patients. Third-party insurers, their purchaser clients, and public sector programs must be scratching their heads about what they are paying for.”

Beginning January 1, 2004, hospitals were required to start submitting data on four types of hospital-acquired infections to PHC4: surgical site infections for three body system categories; and indwelling catheter-associated urinary tract infections, ventilator-associated pneumonia and central line- associated bloodstream infections. As of July 1, 2005, seven additional body system categories for surgical site infections were added to the reporting requirements. Starting January 1, 2006, hospitals were required to submit data on virtually all hospital-acquired infections to PHC4.

Source: PHC4

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