The Cost of Germs

Betsy McCaughey on a lifesaving way to control hospital Medicaid

BY Betsy McCaughey

Ms. McCaughey is a former lieutenant governor of New York State, a health policy expert at the Hudson Institute, and chairman of the Committee to Reduce Infection Deaths at www.hospitalinfection.org.

Too often, patients are contracting deadly infections in hospitals. The humanitarian reasons to correct this problem are obvious. But there is also a compelling economic case, and now is the time to make it, as the Medicaid budget is being discussed.

Governor Pataki wants to lighten the Medicaid burden on taxpayers by cutting payments to hospitals. The Greater New York Hospital Association complains that the cuts — about $800 million — will cause staff shortages and harm patients. One of the smartest ways to control Medicaid costs while actually improving care is to stop the epidemic of infections in our hospitals. New Yorkers are spending a fortune to treat infections, caused mainly by poor hygiene and lax procedures.

Astonishingly, the state allows hospitals to keep their infection rates secret. You can find out if your local deli has been cited for health violations. The state makes it easy to choose a safe deli. But you can’t find out which hospital in your area has the worst infection problem. Here are additional shocking facts:

Every year in this country, 2 million people get infections in the hospital. These infections kill as many people in America as AIDS, breast cancer, and auto accidents combined.

The economic toll is also staggering. A staph infection (staphylococcus aureus), more than triples a patient’s hospital costs. The nation is spending $28 billion a year treating hospital infections. In New York, the cost can only be estimated, because of secrecy, but it’s about $2 billion a year.

A few hospitals in other states are proving that infection can be prevented. Allegheny Hospital in Pittsburgh reduced central-line bloodstream infections by 90% in 90 days. “You can come surprisingly close to eliminating hospital acquired infections with determination as opposed to resources,” reports the hospital’s infection-fighting team.

The Committee to Reduce Infection Deaths, or RID, brings the most successful infection fighters to New York to present their strategies. Recently, a young surgeon described how her hospital reduced infections in the orthopedic unit by 67% and totally eliminated one of the most dreaded bugs, methicillin-resistant staphylococcus aureus, or MRSA.

How was it done? Essentially by making hygiene a central part of medical care again, as it was decades ago before doctors started relying on antibiotics. Hospital workers cleaned their hands meticulously, always wore clean uniforms, made sure that equipment and rooms were thoroughly cleaned after each patient, and stopped wearing any jewelry because bacteria clings to it. Patients planning to be hospitalized were tested for bacteria, and if positive, given simple procedures to follow to eliminate the germs before they came into the hospital.

These precautions yield big returns, tenfold in some cases. Hospitals are complaining that they can’t afford Medicaid cuts. Cutting infection rates can make a financially troubled hospital profitable again. In a recent study of hospitals in 13 states, the 5% of patients who got hospital infections offset 63% of the hospitals’ net operating profits.

What will motivate New York hospitals to improve? Publicizing their infection rates. Reports can be risk-adjusted to be fair to hospitals treating AIDS, cancer, and organ transplant patients, who succumb to infection quickly.

Several New York state legislators are offering bills that would make hospital infection rates available to the public “on request.” That’s not quite enough. When you’re dealing with state government, “on request” could take months. If you need to be hospitalized, you should be able to find out, within minutes, which hospital in your area has the lowest infection risk.

Faced with enormous Medicaid costs and financially ailing hospitals, New Yorkers should insist that hospitals clean up and come clean about their infection problems. What will motivate New York hospitals to improve? Publicizing their infection rates. Reports can be risk-adjusted to be fair to hospitals treating AIDS, cancer, and organ transplant patients, who succumb to infection quickly.