1. Pennsylvania Health Care Cost Containment Council (PHC4) Patrick J. Brennan, head of a panel named by the secretary of Health and Human Services years ago to advise the CDC on infection issues – while not taking a position on mandatory public reporting of infection rates –said: “There is no evidence to support public disclosure as a means to reduce the incidence of these infections.” Letter to the Editor - Marc P. Volavka, Executive Director, PHC4 “Unfortunately, Dr. Brennan was only half right. There is no evidence to support public disclosure because public disclosure of hospital-acquired infection has never occurred.” February 1, 2005

2. Pennsylvania Health Care Cost Containment Council (PHC4) Hospital-acquired Infections In January 2004 PHC4 became one of the first state agencies in the nation to collect hospital data on infections contracted by patients while in the hospital. In January 2004 PHC4 became one of the first state agencies in the nation to collect hospital data on infections contracted by patients while in the hospital.

3. Pennsylvania Health Care Cost Containment Council (PHC4) Using the same definition as CDC’s National Nosocomial Infections Surveillance System (NNIS) Using the same definition as CDC’s National Nosocomial Infections Surveillance System (NNIS)

4. Pennsylvania Health Care Cost Containment Council (PHC4) “ A localized or systemic condition… 1) that results from adverse reaction to the presence of an infectious agent(s) or its toxin(s), and 2) that was not present or incubating at the time of admission to the hospital.” “ A localized or systemic condition… 1) that results from adverse reaction to the presence of an infectious agent(s) or its toxin(s), and 2) that was not present or incubating at the time of admission to the hospital.”

5. Pennsylvania Health Care Cost Containment Council (PHC4) In other words: You didn’t come in with it, and you got it in the hospital… How complicated is that?

6. Pennsylvania Health Care Cost Containment Council (PHC4) PHC4 formed a Hospital-acquired Infection Advisory Panel to help design data collection processes. PHC4 formed a Hospital-acquired Infection Advisory Panel to help design data collection processes. This expert advisory panel included infection control professionals, physicians, medical records specialists and quality assurance representatives. This expert advisory panel included infection control professionals, physicians, medical records specialists and quality assurance representatives. And, we started to get results ! And, we started to get results !

7. Pennsylvania Health Care Cost Containment Council (PHC4)  Surgical site infections for orthopedic surgery, neurosurgery, and surgery related to the circulatory system  All device-related infections for:  certain urinary tract infections  Ventilator-associated pneumonia  Central line-associated bloodstream infection Reporting Requirements - 2004

8. Pennsylvania Health Care Cost Containment Council (PHC4)  11,668 patients were confirmed by PA hospitals as having 4 types of HAI... “tip of iceberg”  1,793 died = 5 Pennsylvanians every day!  205,000 extra days in the hospital  $2 BILLION in additional hospital billing that was sent to someone to pay Hospital Acquired Infections in Pennsylvania Facilities during 2004

9. Pennsylvania Health Care Cost Containment Council (PHC4) Same report (using 2005 data)  19,100 REPORTED HAI’s  12.2 per 1,000 cases  $3.5 BILLION charges in PA  394,000 hospital days!

10. Pennsylvania Health Care Cost Containment Council (PHC4) March 2006 – more research New infections data showed more than $600 million in ACTUAL PAYMENTS! New infections data showed more than $600 million in ACTUAL PAYMENTS! First-of-its-kind data in USA First-of-its-kind data in USA

11. Pennsylvania Health Care Cost Containment Council (PHC4) PHC4 reported NOV. 2006: Payment data from third party payors shows that in 2005: *The average payment for the treatment of a patient with an infection was nearly $54,000 *The average payment was $8,300 for a patient without an infection.

12. Pennsylvania Health Care Cost Containment Council (PHC4) After almost three years of data collection and reporting… PHC4 released the first hospital- specific report on Hospital-acquired Infections in Pennsylvania on November 14, 2006.

13. Pennsylvania Health Care Cost Containment Council (PHC4) HAI Key Findings 19,154 cases reported = 12.2%/1,000 cases 394,129 hospital days $3.5 billion in hospital charges

14. DOES PUBLIC REPORTING WORK? YES ! and it creates SAVINGS OPPORTUNITIES!

15. Now, as riveting as these numbers are for the person paying the tab; here’s an equally compelling “business case” for a hospital CEO:

16. Pennsylvania Health Care Cost Containment Council (PHC4) CCU/MICU and HAI A Big Return on Investment Savings (1 hospital, 1 calendar yr) CLAB = $1,235,765 VAP = $1,003,162 TOTAL HAI elimination initiatives = $2.2M Investment = $35,000 ROI = 63:1 !!!

17. Pennsylvania Health Care Cost Containment Council (PHC4) Hospital Investment Needed Dedication to process improvement Dedication to process improvement Install automated system of measurement (Medmined or other) Install automated system of measurement (Medmined or other) Measure infections! (you cannot improve what you do not account for and measure) Measure infections! (you cannot improve what you do not account for and measure)

18. Pennsylvania Health Care Cost Containment Council (PHC4) Hospital Acquired Infections are NOT inevitable, nor unavoidable!

19. Pennsylvania Health Care Cost Containment Council (PHC4) They are about broken processes of care…and, there are Hospitals, all across this country, that are beginning to demonstrate that HAI’s CAN be reduced or eliminated…

20. Pennsylvania Health Care Cost Containment Council (PHC4) Peer-Reviewed Medical Journal Three NEW articles on HAI’s, Nov/Dec 06 Three NEW articles on HAI’s, Nov/Dec 06 Substantive medical evidence Substantive medical evidence Not reliant on patient case mix Not reliant on patient case mix Not age-associated Not age-associated Not associated with risk factors upon admission Not associated with risk factors upon admission

21. WHAT IS LEFT? PROCESSES OF CARE PROCESSES OF CARE

22. Pennsylvania Health Care Cost Containment Council (PHC4) I’ll end this with a few thoughts about what YOU can do

23. Pennsylvania Health Care Cost Containment Council (PHC4) Cost Containment Options Do Nothing Do Nothing Cut Benefits Cut Benefits Pass It On Pass It On Zero In On The Drivers Zero In On The Drivers Wellness Council of America

24. Pennsylvania Health Care Cost Containment Council (PHC4) ZERO IN ON THE DRIVERS What could be done? Billing Audits Modify unhealthy lifestyles Prevent and treat chronic disease Temper Utilization Improve Quality of Care

25. Pennsylvania Health Care Cost Containment Council (PHC4) Improving Quality PUSH FOR REDUCED PREVENTABLE INFECTIONS AND OTHER ERRORS PUSH FOR REDUCED PREVENTABLE INFECTIONS AND OTHER ERRORS TALK TO PROVIDERS, ASK QUESTIONS, CHANGE CONTRACT STRUCTURES TALK TO PROVIDERS, ASK QUESTIONS, CHANGE CONTRACT STRUCTURES STOP PAYING FOR MEDICAL NEVERS STOP PAYING FOR MEDICAL NEVERS

26. Pennsylvania Health Care Cost Containment Council (PHC4) BY … BY … USING PHC4 TOOLS!

27. Pennsylvania Health Care Cost Containment Council (PHC4) Special Data Requests PHC4 can fulfill customized data requests PHC4 can fulfill customized data requests You supply the SSNs You supply the SSNs We aggregate your data We aggregate your data NO disclosure of individuals’ info NO disclosure of individuals’ info There is a fee for this service – reasonable There is a fee for this service – reasonable Contact Special Requests unit Contact Special Requests unit

28. Pennsylvania Health Care Cost Containment Council (PHC4) For more information on PHC4: 225 Market Street, Suite 400 Harrisburg, PA 17101 (717) 232-6787 www.phc4.org