title: Doing well by doing good: assessing the cost savings of an intervention to reduce central line-associated bloodstream infections in a Hawaii hospital.
abstract: A complete understanding of the financial impact of patient safety interventions must consider the economic incentives of both payers and providers within the current fee-for-service payment model. This study evaluated the impact of a central line-associated bloodstream infection (CLABSI) initiative on costs, reimbursements, and margins for 1 Hawaii hospital and its payers. Intensive care unit patients (January 2009-December 2011) who developed a CLABSI were compared to matched controls. Mean hospital cost, reimbursement, and margin was $222 692 versus $80 144 (P = .01), $259 433 versus $72 543 (P < .01), and $54 906 versus $6506 (P < .01), respectively. Although hospitals and payers reduce costs by preventing CLABSIs, hospitals also would decrease their margins, which creates a perverse incentive to have more line infections. An optimal reimbursement system must reward hospitals and payers for preventing harm rather than treating illness. This study highlights the critical role that health care payers have as patient safety advocates, financial sponsors, and facilitators.
authors: 1Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD.
authors: Eugene
authors: E
authors: Hsu
authors: Della
authors: D
authors: Lin
authors: Samuel J
authors: SJ
authors: Evans
authors: Kamran S
authors: KS
authors: Hamid
authors: Kevin D
authors: KD
authors: Frick
authors: Ting
authors: T
authors: Yang
authors: Peter J
authors: PJ
authors: Pronovost
authors: Julius Cuong
authors: JC
authors: Pham
mesh_terms: D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000191:economics / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D017046:Cost Savings / Q000191:economics / Q000379:methods; D003428:Cross Infection / Q000191:economics / Q000517:prevention & control*; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D062606:Tertiary Care Centers / Q000191:economics
keywords: cost savings; critical care; health care economics and organizations; health care quality access and evaluation; insurance health reimbursement; patient safety