Maryn McKenna

Journalist and Author

Not-reimbursing hospitals for MRSA: The reaction

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You’ll remember that early in the summer we talked about the proposal by the Center for Medicare and Medicaid Services to cease reimbursing hospitals for the additional care of a patient that is required when a hospital gives a patient a nosocomial infection. CMS has been debating whether to include several types of hospital-acquired infection in the 2009 iteration of its “never event” no-reimbursement list. (CMS has not announced its final choices.)

Healthcare’s reaction has been, hmmm, not positive. At The New Health Dialogue, Joanne Kenen captures the reactions, many of which run along the lines of “infections are inevitable because patients are so sick.” But she’s also found a marvelous (and appalling?) argument that goes, more or less, “Preventing infections will be more costly, not less, because hospitals will introduce additional procedures to protect themselves.”

This recalls the intriguing and dismaying suggestion in JAMA a few weeks ago that “search and destroy” active surveillance is driven less by wanting to halt in-hospital transmission and more by hospitals wanting to build a case that patients brought the infection with them.

Surveillance to stop MRSA: Where, when, how costly, how much?

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My colleague Joanne Kenen — longtime health policy correspondent for Reuters, now a staff member at the New American Foundation, and a Henry J. Kaiser Family Foundation Media Fellow with me in 2006-07 — very kindly invited me to guest-blog at the New Health Dialogue. Most of the post is reproduced below, but please be kind and visit them so they can record the hits!

Stopping the spread of MRSA in hospitals is one of the most contentious topics in infectious disease policy right now. A small sample of the, umm, highly divergent views on the subject filled up the letters pages of the Journal of the American Medical Association last week. Community-associated MRSA has grabbed the public’s attention over the past year, but hospital-acquired MRSA remains a huge problem — so much so that the Center for Medicare and Medicaid Services has proposed treating it as a medical error and declining to reimburse hospitals for the extra care that must be given to a patient when it occurs.

Within health care, there is vociferous debate over how to control MRSA. Because MRSA can live on the skin, nostrils and other body sites for a long period of time before causing an infection — either in the person colonized by the bug or in someone else who acquired it from the colonized person — many hospitals espouse a program of checking new patients who are most likely to be carriers, including patients in high-risk units such as ICUs, new admits from long-term care facilities, and people who have had MRSA infections on the past. But a small set of institutions are pursuing a more aggressive program, variously called “active surveillance and testing,” “universal screening” or “search and destroy,” that checks every inpatient for MRSA colonization and confines them to isolation until the bug has cleared.

“Search and destroy” was the topic of an important JAMA paper and editorial last March that decided the effort wasn’t worthwhile. (A simultaneously published paper in the Annals of Internal Medicine completely disagreed.) The five letters in JAMA tear the topic apart, examining definitions, methodology, cost-effectiveness, adherence to infection control and more. The most intriguing suggests that “search and destroy” contains a hidden agenda: That if hospitals can demonstrate patients were carrying MRSA on admission, they may be able to make a case for any subsequent infections not being their fault — and so escape the lowered reimbursement rates that CMS proposes.