Three scenarios of clinical claim reimbursement for nosocomial infection: the good, the bad, and the ugly

Vegni, Fe; Panceri, Ml; Biffi, M. R.; Banfi, Elena; Privitera, Gaetano Pierpaolo

doi:10.1016/j.jhin.2003.10.014

Cited by 7 publications

(8 citation statements)

References 23 publications

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“…This finding is particularly important to consider in countries working with a prospective DRG reimbursement system. 3,25 Insurance companies are not necessarily obliged to pay a healthcare facility for treatment of HAIs or for additional infection control measures of patients colonized with nosocomially acquired MDROs, which can put a hospital in a precarious financial situation. To maximize a hospital's cost-effectiveness, it is essential to minimize the number of HAIs and also to minimize the patient's length and expenses of hospital stay.…”

Section: Discussionmentioning

confidence: 99%

“…However, only transmission of MDROs within the hospital can be prevented by an infection control program. 25 Several limitations of the study should be mentioned. First, our MDRO results cannot be extrapolated one to one to other HAIs such as catheter-related bloodstream infections, pneumonia or surgical-site infections.…”

Section: Discussionmentioning

confidence: 99%

“…To maximize a hospital’s cost-effectiveness, it is essential to minimize the number of HAIs and also to minimize the patient’s length and expenses of hospital stay. However, only transmission of MDROs within the hospital can be prevented by an infection control program 25 …”

Section: Discussionmentioning

confidence: 99%

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Multidrug-Resistant Organisms Detected More Than 48 Hours After Hospital Admission Are Not Necessarily Hospital-Acquired

Erb

Frei

Dangel

et al. 2016

Infect. Control Hosp. Epidemiol.

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BACKGROUND Infections and colonization with multidrug-resistant organisms (MDROs) identified >48 hours after hospital admission are considered healthcare-acquired according to the definition of the Centers for Disease Control and Prevention (CDC). Some may originate from delayed diagnosis rather than true acquisition in the hospital, potentially diluting the impact of infection control programs. In addition, such infections are not necessarily reimbursed in a healthcare system based on the diagnosis-related groups (DRGs). OBJECTIVE The goal of the study was to estimate the preventable proportion of healthcare-acquired infections in a tertiary care hospital in Switzerland by analyzing patients colonized or infected with MDROs. METHODS All hospitalized patients with healthcare-acquired MDRO infection or colonization (HAMIC) or according to the CDC definition (CDC-HAMIC) were prospectively assessed from 2002 to 2011 to determine whether there was evidence for nosocomial transmission. We utilized an additional work-up with epidemiological, microbiological, and molecular typing data to determine the true preventable proportion of HAMICs. RESULTS Overall, 1,190 cases with infection or colonization with MDROs were analyzed; 274 (23.0%) were classified as CDC-HAMICs. Only 51.8% of CDC-HAMICs had confirmed evidence of hospital-acquisition and were considered preventable. Specifically, 57% of MRSA infections, 83.3% of VRE infections, 43.9% of ESBL infections, and 74.1% of non-ESBL MDRO infections were preventable HAMICs. CONCLUSIONS The CDC definition overestimates the preventable proportion of HAMICs with MDROs by more than 50%. Relying only on the CDC definition of HAMICs may lead to inaccurate measurement of the impact of infection control interventions and to inadequate reimbursement under the DRG system. Infect. Control Hosp. Epidemiol. 2016;1-6.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Multidrug-Resistant Organisms Detected More Than 48 Hours After Hospital Admission Are Not Necessarily Hospital-Acquired

Erb

Frei

Dangel

et al. 2016

Infect. Control Hosp. Epidemiol.

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“…Over the past years several adjustments of the DRG system have been made, whereby also hospital acquired infections with multidrug-resistant pathogens should be better reflected. Originally, these costs were not included in DRGs and therefore not covered (Vegni et al, 2004). A positive MDRO-status can be indicated by the secondary diagnosis U80.0!…”

Section: Encoding Of Multiresistant Organism In the German Drg-systemmentioning

confidence: 99%

“…A few studies demonstrate a positive cost-benefit ratio of theses hygiene preventive measures (Farbman et al, 2013). Nevertheless, these additional costs are only partly accounted in hospital financing systems (Vegni et al, 2004). The financial impact of nosocomial infections on reimbursements under prospective Diagnosis Related Group (DRG) conditions is already long controversially debated (DeWitt, 1987).…”

Section: Introductionmentioning

confidence: 99%

Reimbursement for Hospital-acquired Infections with Multidrug Resistant Organisms in German DRG System

Hübner¹,

Fleßa²

2016

Economics &Amp; Sociology

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Hospital-acquired infections (HAIs), especially caused by multidrug resistant organisms (MDROs) are one of significant cost drivers for healthcare systems worldwide, associated, inter alia, with additional costs for hospitals. An empirical study was conducted to analyse whether changes in German DRG system led to a better coverage of increased expenditure due to HAIs and the related prevention procedures. 784 patient records from six hospitals in Northeast Germany, documentation sheets as well as routine medical controlling data (including age, sex, length of stay, main diagnosis, secondary diagnoses, OPS-codes, DRG, effective cost weight) have been analysed. Study population showed overall an increased length of stay but higher in the MDRO-positive group. Average cost weight was increased by 1.74, average effective cost weight by 2.13. However, MDRO-patients gather lower revenue per day on average. The study demonstrated that MDRO-parameters are not fully incorporated in the applied DRG-coding procedures and hygiene expenditures are still underfunded.

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Additional direct medical costs of nosocomial infections: an estimation from a cohort of patients in a French university hospital

Defez

Fabbro‐Peray

Cazaban

et al. 2008

Journal of Hospital Infection

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Three scenarios of clinical claim reimbursement for nosocomial infection: the good, the bad, and the ugly

Cited by 7 publications

References 23 publications

Multidrug-Resistant Organisms Detected More Than 48 Hours After Hospital Admission Are Not Necessarily Hospital-Acquired

Multidrug-Resistant Organisms Detected More Than 48 Hours After Hospital Admission Are Not Necessarily Hospital-Acquired

Reimbursement for Hospital-acquired Infections with Multidrug Resistant Organisms in German DRG System

Additional direct medical costs of nosocomial infections: an estimation from a cohort of patients in a French university hospital

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