How Payers Can Assist Hospitals In Managing Antibiotic Use
Healthcare payers can serve as primary catalysts to help hospitals make significant progress in their battle to stem the rising tide of resistant bacteria and in the effectiveness of their antibiotic stewardship programs (ASPs).
Beginning next year, the Centers for Medicare & Medicaid Services (CMS) may require hospitals to implement ASPs in order to participate in Medicare reimbursement. Some hospitals are likely to take the “checkbox” approach to compliance despite the critical importance of implementing ASPs that yield meaningful results.
A recent study in the journal Clinical Infectious Diseases revealed that 41% of large hospitals (more than 200 beds) and 75% of hospitals with fewer than 50 beds failed to implement all seven core elements of the Centers for Disease Control and Prevention’s recommendations for an effective ASP. Payers can influence these facilities to implement comprehensive programs rather than merely check the required boxes needed for “compliance.”
In fact, payers already have information that could be used to encourage providers’ ASP efforts. For example, all cases of the hospital-acquired infection Clostridium difficile (C. difficile) must be reported to CMS. High rates of C. difficile are a clear indicator of increased broad-spectrum antibiotic use. Moreover, patients who develop C. difficile have a 20% chance of hospital readmission within 30 days.
As the largest public payer, CMS penalizes hospitals with high readmission rates that may be due, in part, to C. difficile. Private payers can incentivize hospitals to reduce C. difficile cases, resulting in reduced readmissions, improved outcomes, and lower overall cost of care.
Some hospitals have ASPs in place, but still experience high rates of C. difficile, along with the exorbitant costs of patient quarantine and room disinfection. A truly effective ASP program requires transformational change in organization-wide prescribing patterns. Every hospital and physician should follow the mantra of “aggressive diagnostics, conservative therapeutics” to curb empiric, “just-in-case” prescribing. Thanks to advances in rapid diagnostics, physicians and hospitals now can access timely data to determine whether an antibiotic is even needed.
ASPs Are a Patient Safety Issue
As providers and payers work together to more effectively implement and manage ASPs, they face challenges such as the best use of terminology. For example, studies have shown the term “antibiotic stewardship program” doesn’t resonate with clinicians or patients. The terminology used with these constituents must be framed as a patient safety issue in order to effectively communicate. The routine prescription of broad-spectrum antibiotics–one patient at a time–is, in fact, a patient safety issue. Such behavior gravely affects the bacteriology and health of the entire community.
Many hospitals and health systems have clinicians on staff who thoroughly understand the science of antibiotic stewardship. But that doesn’t guarantee that those hospitals are achieving stellar results in protecting the public from the consequences of antibiotic overuse. In some cases, rural and medium-sized hospitals are outperforming academic medical centers in curbing empiric prescribing patterns and lowering overall antibiotic costs.
Payers have a strong desire to foster change because they bear much of the cost associated with the overuse of broad-spectrum antibiotics. They are in the position to establish incentives and value-based contracts that help reduce the current empiric prescribing patterns that ultimately endanger long-term community health.
Payers also are pragmatic and results-oriented. They understand that some ASP efforts likely are to be programs in name only. Payers can, and will, increasingly require hospitals and physicians to document their successes in antibiotic stewardship.
James M. Keegan, M.D., is an infectious disease specialist who directs the Antibiotic Stewardship service line at PYA, a healthcare consulting group.
