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Programs true worth prevents deep cuts
Cost-cutting consultants — none of them apparently steeped in hospital epidemiology training — recommended whacking 50% of the resources from the infection control program at the University of Virginia (UVA) Health System in Charlottesville last year. Infection control professionals there — to say the least — were not amused and successfully fought the cuts with some cost figures of their own.
This cautionary, and increasingly familiar tale, was told recently by David Calfee, MD, medical epidemiologist at the UVA system, at the annual meeting of the Society for Healthcare Epidemi-ology of America (SHEA) in Toronto.
"In 2000, the hospital’s administration asked a consultant group to provide recommendations regarding additional cost- containment strategies," he told SHEA attendees. "Many of the recommendations provided by this consultant group related to downsizing certain programs with the intent to right-size’ programs that they felt were either too large or unnecessarily costly. One such recommendation was to reduce the infection control program by 50%."
The recommendation was apparently based on comparison with nine university hospitals of similar size and complexity that had responded to an e-mail survey conducted by the consultant group.1 They then recommended the cuts under "the assumption that all infection control programs, regardless of size, administer the same benefits, thus leading to the conclusion that smaller programs would, therefore, be more cost-effective," Calfee said.
Factors such as the scope of the infection control activities performed, rates of nosocomial infections, and antibiotic-resistant infection rates were not considered in the consultants’ comparison. Infection control personnel from the nine comparison hospitals were contacted by UVA clinicians and asked to provide additional information regarding those additional factors.
The UVA program particularly is active in identification and isolation of patients colonized and/or infected with antibiotic-resistant organisms such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, he noted. To continue these efforts in the face of expanding program responsibilities, two additional staff members have been added to the program. The additional activities include HIV education, outpatient infection control, and exposure control plan development to meet regulatory requirements.
The survey of the infection control programs to which UVA was compared found that none of the smaller programs were performing a similar intensity of surveillance for MRSA or VRE. Thus, they had a lack of data that prevented meaningful comparison of nosocomial infection rates with a hospital actively seeking to identify and isolate such cases. However, several facilities were able to provide the number of nosocomial and MRSA and VRE bacteremias, which were considerably higher than the number at UVA.
"Many of these comparison hospitals reported they had experienced recent relative or absolute downsizing of their programs," Calfee said. "Some programs have undergone absolute downsizing as the result of similar consultant recommendations."
With their screening program leading to prompt identification and isolation of patients — thus preventing subsequent transmission to other patients by unrecognized source patients — Calfee and colleagues gave administration some bottom-line information on prevented bloodstream infections (BSI). The hospital was saving between $891,000 to $2.8 million annually by preventing costly BSI infections due to MRSA and VRE. Thus, the consultants were put to flight, and the infection control program proved budget cuts would only set off higher subsequent costs.
While an excellent analysis, one SHEA audience member noted that one other cost factor should have probably been included: the consultants’ charges to the hospital.
1. Calfee D, Farr B. Infection control in the era of managed care. Abstract 127. Presented at the Society for Healthcare Epidemiology of America. Toronto; April 2001.