U.S. hospitals are reducing bloodstream infections related to catheters by implementing rigorous safeguards that also save millions of health care dollars each year, according to a new study led by the Cedars–Sinai Medical Center in Los Angeles, California.

The researchers studied data published during the last decade on catheter-related bloodstream infections at 113 hospitals. They found that safety interventions, on average, reduced the infection rate by 57% at these hospitals while producing net savings of $1.85 million for each site during three years. The savings came from reduced costs in treating infected patients.

The study, published in JAMA Internal Medicine, focused on central venous catheters, which are commonly used in intensive care units. More than 60,000 primary bloodstream infections related to these catheters are estimated to occur each year in the United States, with a fatality rate of 12% or more, according to recent studies.

To prevent these infections, hospitals have introduced new safety procedures. Checklists for attending staff include donning sterile gloves, covering catheters with antimicrobial dressings, and checking catheters daily for signs of movement or infection. Many hospitals also have invested in extra training, equipment, and supplies to improve safety.

The phasing in of these safeguards correlated with a 49% reduction nationally in the rate of catheter-related bloodstream infections from 2010 to 2013, according to the federal Agency for Healthcare Research and Quality. The new study showed that these safeguards, while adding to equipment and labor costs, ultimately reduced infections and saved money.

In the hospitals studied, the median cost of implementing catheter safety programs was approximately $270,000 per site. But for every $100,000 that a hospital spent, it realized an average $315,000 savings because it treated fewer infected patients, the investigators found. Although savings were lower in certain hospitals that already had low infection rates, adding new precautions still paid off for them.

Lead investigator Teryl Nuckols, MD, MSHS, said that the study supports the value of medical centers upgrading their safety procedures to prevent catheter infections.

“Due to the high cost of caring for patients when central-line infections develop, even sizable up-front investments in infection prevention can be associated with large net savings,” Nuckols said. “On the basis of our findings, hospitals that have not yet achieved very low rates of infection can consider implementing a variety of safety practices.”

Sources: Medical Xpress; January 9, 2017; and JAMA Internal Medicine; December 2016.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.