1. Update SB 288: Health Care Associated Infections Infectious Disease Epidemiology Workgroup Jan. 9, 2009 Austin, Texas Gary Heseltine MD MPH Infectious Disease Control Unit “When speculation has done its worst, two and two still make four.” Samuel Johnson, The Idler

2. SB 288 Mandatory Public Reporting of Healthcare-associated Infections 80 th Regular Legislative Session 2007 Hospitals, Ambulatory Surgical Centers (ASCs) to report specific HAIs to DSHS using CDC case definitions Must begin no later than 6/1/08 Minimum once per year, maximum each quarter Must contain sufficient patient ID data –avoid duplication –verify accuracy and completeness –allow for risk adjustment DSHS will review data for validity and “unusual data patterns or trends”

3. SB 288 Advisory Panel Activities Six meetings in 2008 Recommended use of NHSN for reporting –ASC not supported by NHSN –Public reporting remains problematic Letter to commissioner stressing funding Talking points developed for legislature Sixteen member Advisory Panel– two year term

4. Adult Reportable SSI Infections colon surgeries hip and knee arthroplasties abdominal and vaginal hysterectomies CABG and vascular procedures Pediatric Reportable SSI Infections Cardiac procedures excluding thoracic cardiac VP shunt procedures Spinal surgery with instrumentation And (non-SSI) respiratory syncitial virus infection

5. Reportable Central Line Infections Lab confirmed from a patient in any “special care setting in the hospital” Alternative Reporting Report SSIs related to the 3 most frequently performed procedures from the National Healthcare Safety Network (NHSN) procedure list For facilities with an average < 50 procedures/monthly

6. Intersecting Activities Outside DSHS DHHS action plan for HAI –Seven metrics identified including MRSA and C diff infections –SCIP data already reported via Hospital Compare CMS non-reimbursement for “never events” –Will not pay for increased costs –Private insurers follow suit –Importance of POA diagnostic codes

7. Intersecting Activities Outside DSHS con’t TJC patient safety goal 7 –Focus on epidemiologically important MDROs –Implement best practices preventing CLBSI, SSIs and measure Conclusion Multiple partial overlap with SB 288 Need for uniform case definitions and ability to share data Need to harmonize demands placed on facilities for reporting.

8. Unified Approach to Quality and Patient Safety Integrate existing and proposed data reporting initiatives Increase compliance with harmonized standards Reduce burden and cost for providers and state through unified approach to regulation Improve quality while reducing cost through improved provider performance and reimbursement incentives Integrated Data Reporting on Enhanced Web Site Improved Provider Performance Harmonized Standards and Guidelines Validated Data Improved Performance Rewarded (P4P) Unified Approach to Regulation Standardize d data formats

9. Reporting Mechanism Plan A: Missouri Healthcare System –Associated Infection Reporting System- large IT project Plan B: National Health care Safety Network – initially viewed as complex and burdensome to ICP –currently recommended by HAI panel –DSHS build IT system to receive/display NHSN data Plan C: Use Texas Hospital Discharge Data Network –Already reaches statewide except rural hospitals and will be expanded to all ASCs under existing legislation –Problems include data definitions, legal ability to share, contracts Plan D – as needed Option for public to report suspected HAIs to DSHS –Poses significant challenges, particularly validation

10. SB 288 Funding For FY 2008 DSHS requested $4.5M, 36 FTEs –LBB calculated $1.1M and 5 FTEs FY 2009 DSHS requested $3.7M –LBB calculated $1.2M and 8 FTEs Other scenarios presented Current status = not funded Presented as an exceptional item What is the best investment for Public Health?