Report: Costs Soar When Hospital Patients Are Infected

By Christopher Snowbeck, Pittsburgh Post-Gazette

Mar. 29–When patients acquire infections during the course of a stay in a hospital, insurance companies wind up paying more than seven times as much for their care as for patients who don’t get an infection.

That finding from a report being released today by the Pennsylvania Health Care Cost Containment Council goes the furthest toward putting a price tag on the long-standing problem with infections in state hospitals. But the report was immediately criticized by hospital officials, who acknowledged the severity of the problem but called the new study “unscientific” and “of little use to patients or health-care providers.”

Last summer, the council released a groundbreaking report that found more than 11,000 patients in Pennsylvania hospitals acquired infections during hospital stays in the previous year. The new report tracked what insurance companies paid hospitals for the treatment of 1,119 of those infected patients — those with pneumonia, surgical site, urinary tract or bloodstream infections.

The council found that the average payment for patients with these infections was $60,678, compared with $8,078 for patients without the infections. The additional $52,600 per patient added up to an extra $58.8 million for the hospitals, the council found.

The report looked only at payments from commercial insurers. It excluded payments from the Medicare and Medicaid programs, which pay for a large share of the care provided in hospitals. But by applying the ratios from the commercial population to the government health plans, the council estimated that additional total payments from all insurers for hospital-acquired infection cases during 2004 was $613.7 million.

Previous attempts to put a dollar figure on the infection problem relied on what hospitals charged insurance companies for the care provided, but were criticized as overstating the problem since hospitals typically receive from health plans only a fraction of the amount they charge.

“This is the first report in the country that will actually identify real payments,” said Marc P. Volavka, the council’s executive director.

“Here’s your take-home message: If you go to the hospital and get an infection, you are seven times more likely to die than someone who doesn’t, and whoever is paying the bill is going to pay, on average, more than seven times more for the privilege of getting the infection,” Mr. Volavka said.

But the Hospital & Healthsystem Association of Pennsylvania strongly questioned the council’s math.

The council wrongly attributed all of the increased payments to infections, rather than identifying costs due to the underlying disease, said Carolyn F. Scanlan, the hospital association president, in a statement. The council’s report should have compared costs among those patients with the same diagnosis, or among those who received the same sort of care, she said.

“Comparing large groups of low-risk, short-stay, low-cost patients to those who are among the sickest patients is not sound statistics,” Ms. Scanlan said. “Patients who require a ventilator or a central line — are far sicker and will always be significantly more costly to treat, even if they do not contract an infection.”

Dr. Richard Shannon, the chairman of medicine at Allegheny General Hospital, said the council’s numbers, nonetheless, shed light on how infections multiply the cost of care, even if the factor by which costs increase can vary.

Allegheny General, which has been lauded for its efforts to eliminate hospital-acquired infections, has worked to eliminate from its intensive care units bloodstream infections and ventilator-associated pneumonia — two of the infections studied in the new report. Their work has shown that insurers wind up paying anywhere from twice to 10 times as much for the care of patients within the same diagnosis group depending on whether they come down with an infection, Dr. Shannon said.

In addition to causing financial harm to health plans, hospital-acquired infections harm hospitals, too.

“Even though the payments are greater, the costs of care are so much greater that the margin is negative” and hospitals lose money, Dr. Shannon said. “That is in the overwhelming majority of cases that we’ve examined.”

The work at Allegheny General suggests that as much as 90 percent of the infections being tracked by the council could be prevented in a year’s time if hospitals paid better attention to hygiene and standardized how intensive care unit patients receive care, Dr. Shannon said.

Both Dr. Shannon and Mr. Volavka will be testifying about the infection issue today before the House Subcommittee on Oversight and Investigations in Washington, D.C. In his prepared comments, Mr. Volavka will stress that hospital-acquired infections are not inevitable and can be prevented with low-tech interventions such as hand washing, using gloves and properly sterilizing equipment.

Beyond calculating the price tag for infections during 2004, the council’s report being released today shows that Pennsylvania hospitals reported 13,711 infections in the first nine months of 2005 — an increase over the 11,668 reported in all of 2004. Mr. Volavka said the increase represented an improvement in reporting rates, not necessarily an increase in the actual number of infections.

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