Hospital Acquired Infections, Serious Reportable Events Responsibility of the Board of Trustees

1. Hospital Acquired Infections,Serious Reportable EventsResponsibility of the Board of Trustees The Leapfrog Conference on the Future of Hospital Governance January 28, 2008

2. Hospital Acquired (Nosocomial) Infections • Healthcare-associated infections (HAIs) are a serious public health issue in the United States. HAIs are the most common complication affecting hospitalized patients, with between 5 and 10 percent of inpatients acquiring one or more infections during their hospitalization. CDC report estimates 1.7 million HAIs occur each year in the United States, accounting for an estimated 99,000 deaths. This adds $4.5 to $5.7 billion in healthcare costs (NQF 2007) • GM • 330 deaths per year (1 per day), $15-$19 million

3. Serious Reportable events • 28 Events that should never happen in a hospital that are preventable. • Vetted and endorsed by NQF • Rare, but result in death or serious harm • Includes: • Surgical Events • Product or Device Events • Criminal Events

4. HAI SRE Implementation Components Health Plan provider contracting requirements Performance measure endorsement Public, Private Purchaser alignment CMS No Payment Policy Public Reporting incentives Public Reporting, P4P programs Health Care Information Technology Patient Institute for Health Care Improvement Provider engagement tools Board of trustees Board training Board Recruitment Employee Retiree Education Community, Regional collaboratives

5. Leapfrog PolicySerious Reportable events • Apologize to the Patient and Family Affected • Report the event to at least one reporting program (JCAHO, State, Patient Safety org) • Conduct a Root Cause Analysis • Waive all costs directly related to the serious reportable event and refrain from seeking payment from the patient or third party payer • Apply policy to Hospital Acquired Infections

6. CMS Reporting and Payment Policy on SRE/HAI • 11 Complications/Conditions • POA Reporting effective October 1, 2007 • Non Payment effective October 1, 2008 • Start up set of conditions: • Follow CMS policy for all GM and other interested purchaser beneficiaries

7. CMS Reporting and Payment Policy11 Complications/Conditions • Object left in surgery • Blood incompatability • Air embolism • Falls • Surgical site infection following heart surgery • Catheter associated urinary tract infections • Pressure ulcers • Vascular catheter associated infections • *Ventilator associated pneumonia • *Septicimia • *Deep vein thrombosis • *effective 2009

8. CDC Estimate: % of health care associated infections • Urinary Tract Infections: 32% • Surgical Site Infections: 22% • Pneumonia (Lung Infections): 15% • Bloodstream Infections: 14% • Total: 83%

10. Board of Trustees Strategy • Identify executives that are on health care organization boards • Identify key hospitals where board representation would be important and develop strategy for engagement • Develop and implement board training and training opportunities

11. Board of Trustees Role • Hold CEO accountable for development and achievement of Quality and Safety Goals and provide strong support • Participate as a board in development of explicit criteria to guide medical staff credentialing and privileging including compliance • Make sure that the board quality committee reviews performance and action steps to improve • Do not accept the culture that SRE, HAI are normal

12. Current InitiativesSerious Reportable events, HAI • Leapfrog • Keystone • CMS • NBGH • NBCH • Veterans Administration • Henry Ford Health System • Virginia Mason • Geisinger • WellPoint • United • Humana • Institute for Health Care Improvement

13. Discussions to date • CMS • NQF • AHRQ • Leapfrog • National Business Group on Health (NBGH) • National Business Coalition on Health (NBCH) • Henry Ford Health System, HAP • BCBSM • WellPoint • Michigan Hospital Association/Keystone • Institute for Health Care Improvement • Ford • Chrysler • DTE • JCAHO

14. StrategyHospital Acquired Infections • Develop Policy, Principles Language • Work, coordinate with coalitions: NBGH, NBCH, Leapfrog • Engage other purchasers (public, private, unions) • Gain Public Purchaser Support • Work with CMS to accelerate list of conditions • BCBSM, WellPoint support, implementation • HMO support, implementation

15. StrategyHospital Acquired Infections • Engage Early Adopter Providers • Advocate performance measure development and implementation • Research support • Identify Resources, examples for hospitals • Communications Strategy (Internal, External) • Develop Evaluation Plan

16. IssuesHospital Acquired Infections • Feasibility to get to 6sigma: Yes, but hard work • Patient hold harmless • Coding • Screening for present on admission or high risk • Data sources (internal, external) • Common policy among carriers • Definitions • Hospital contracting cycle • Payment for non hospital follow up care • Malpractice • Momentum • Ramifications, unintended consequences

17. Summary • GM and GM beneficiaries should not pay hospitals (or other providers) for costs created by Hospital Acquired Infections or for Serious Reportable Events as endorsed by NQF • Carriers initiate steps to implement CMS policy as soon as possible • GM work with Leapfrog, NBGH, NBCH to implement reporting and compliance • Board of Trustees engagement and education We need your leadership and support