September 28th, 2009

Writes the Times-Tribune in an editorial today:

As controversies over the cost and effectiveness of health care have raged over the course of the decade, Pennsylvania hospitals gradually have improved their performance in several areas – especially in reducing patient mortality.

The Pennsylvania Health Care Cost Containment Council’s annual report on hospitals has found that the death rate, for 20 conditions it has tracked since 2002, fell from 5.1 percent in 2002 to 4.2 percent in 2008. That’s a decrease of more than 17.5 percent.

Most impressive was the decline in mortality rates for hemorrhagic stroke victims, which fell from 33.7 percent in 2002 to 26.2 percent in 2008, a decrease of more than 22.5 percent.

But the report also found that, as an industry, Pennsylvania hospitals have yet to get a handle on a key driver of the rapid escalation in health care costs – readmissions due to preventable hospital-acquired infections.

According to the PHC4, 57,582 patients were readmitted to hospitals in 2008, creating an additional $2.5 billion in costs and 350,000 billable hospital days.

Many of those readmissions are due to the regular course of care, such as for chemotherapy or a series of surgeries resulting from a single trauma. And some result from the declining mortality rates, as patients who might otherwise have died seek follow-up care.

But 38.2 percent of all readmissions were for treatment of hospital-acquired infections, the PHC4 reported. Those 22,094 readmissions created $1.1 billion in charges and 157,000 additional hospital days.

Reducing the number of infections that require readmission is one key to health care reform that has nothing to do with politics or government policy because doing so reduces overall costs.

Medicare has begun pilot programs to deny payments for treatment of some hospital-acquired infections, and some private insurers are considering doing so.

In Pennsylvania the rate of readmissions due to hospital-acquired infections has hovered around 19 percent. The PHC4 reporting process, the first in the nation, has helped to produce public pressure for vastly reduced infection rates. That rates have not grown indicates some progress, but state and federal regulators and hospitals themselves must increase the effort to reduce hospital-acquired infections, thus improving patient safety and slowing the rise of health care costs.