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I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
CathDr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.auMESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
Hi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
______________________________________________________________________
For the purposes of protecting the integrity and security of the SVHA network and the information held on it, all emails to and from any email address on the “svha.org.au” domain (or any other domain of St Vincent’s Health Australia Limited or any of its related bodies corporate) (an “SVHA Email Address”) will pass through and be scanned by the Symantec.cloud anti virus and anti spam filter service. These services may be provided by Symantec from locations outside of Australia and, if so, this will involve any email you send to or receive from an SVHA Email Address being sent to and scanned in those locations.Click here to report this email as spam.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
______________________________________________________________________
For the purposes of protecting the integrity and security of the SVHA network and the information held on it, all emails to and from any email address on the “svha.org.au” domain (or any other domain of St Vincent’s Health Australia Limited or any of its related bodies corporate) (an “SVHA Email Address”) will pass through and be scanned by the Symantec.cloud anti virus and anti spam filter service. These services may be provided by Symantec from locations outside of Australia and, if so, this will involve any email you send to or receive from an SVHA Email Address being sent to and scanned in those locations.Click here to report this email as spam.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
Cath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regardsSharon
Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au[cid:image005.png@01D0774C.C15F6A20]
Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’ (without the quotes) to listserv@aicalist.org.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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______________________________________________________________________
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HI Cath
We have data from various prospective trials and hospital databases, you
are welcome to PM me if there is something specific you would like.
In a recent trial (1 line per patient) CRBSI (not CLABSI) was PICCs
(N666) 1.5%, CVCs (N865) (pooled tunneled, non-tunneled, & ports) 2.2%,
arterial lines (N680) 0.5%, PIVs (N5907) 0.02%.
Healthy wishes
COn 29 August 2016 at 17:08, Dr Cathryn Murphy wrote:
> Here is the companion old chestnut question that goes with better public
> reporting.
>
>
>
> Is any state aware of new penalties introduced for public hospitals?
>
>
>
> I am aware of Medibank contractual obligations with more than 120 of its
> private hospitals not to cover any additional costs that result from
> certain types of hospital complication or associated re-admissions where
> there is good evidence that these types of complication could be reduced or
> avoided.
>
>
>
> Is the public sector still tolerating CLABSIs without penalty?
>
>
>
> https://www.medibank.com.au/content/about/transforming-
> health/hospital-contracts.html
>
>
>
>
>
> Warm regards
>
> Cath
>
>
>
> Cathryn Murphy MPH PhD CIC
>
> Chief Executive Officer & Creative Director
>
> Infection Control Plus Pty Ltd
>
> PO Box 3079
>
> Burleigh Town 4220
>
> OLD, Australia
>
>
>
> E: Cath@infectioncontrolplus.com.au
>
> M: +61 428 154154
>
> W: infectioncontrolplus.com.au
>
>
>
>
>
>
>
>
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] *On
> Behalf Of *Brett Mitchell
> *Sent:* Monday, 11 May 2015 13:17 PM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: Non-payment for non-performance and BSIs
>
>
>
> Hi Michael and Cath,
>
>
>
> Very interest topic. It is also worth noting the value of released bed
> days from infections prevented. There are some good papers on this,
> including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth –
> http://journals.cambridge.org/action/displayAbstract?
> fromPageonline&aid9497698&fileIdS0195941700094418
>
>
>
> You may be interested to hear that this theme and variations thereof, are
> being explored in ACIPC conference this year. Andrew, Nick and Stephan are
> presenting at this conference. There is also a moderated discussion being
> led by an ABC presenter which will discuss the merits and issues in a
> similar theme to the one raised. This discussion with include the CEO of
> the NHPA. More on this to come
>
>
>
> Going to the point of LOS, as you will both know, it is critical such
> calculations of excess LOS due to an infection are done correctly. All too
> often the wrong analysis is undertaken. Adrian Barnett will be talking
> about this during the conference as well.
>
>
>
> Thanks
>
>
>
> Brett
>
>
>
>
>
>
>
> *Associate Professor Brett Mitchell*
>
> Associate Professor of Nursing, *RN, BN, PhD, M.Adv.Prac, CICP, MRCNA*
> *Faculty of Nursing and Health and Director Lifestyle Research Centre**, *
> *Cooranbong*
>
>
> Avondale College Ltd trading as Avondale College of Higher Education
> ACN: 108 186 401 | ABN: 53 108 186 401 | CRICOS: 02731D | TEQSA: PRV12015
> http://www.avondale.edu.au | http://www.designedforlife.me
>
> 185 Fox Valley Road, Wahroonga NSW 2076 Australia
> Telephone: 02 9480 3613 (Sydney Campus Tues-Thurs)| 02 4980 2397 (Lake M
> Monday) Fax: 02 9487 9625
>
>
>
> *From:* ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU
> ] *On Behalf Of *Michael Wishart
> *Sent:* Friday, 8 May 2015 9:16 AM
> *To:* AICALIST@AICALIST.ORG.AU
> *Subject:* Re: [ACIPC_Infexion_Connexion] Non-payment for non-performance
> and BSIs
>
>
>
> [Posted on behalf of Robert Lansdown, advertising material removed as per
> Rules Moderator]
>
>
>
> Hi Cath,
>
>
>
> Ive always taken a keen interest in funding mechanisms and in particular
> non-payment for non-performance mechanisms for HAIs and I researched the
> topic fairly extensively back in early 2013 prior to writing the attached
> article for our IPH Advisor newsletter (as Mayo Healthcare before our
> transformation to Teleflex Medical Australia). The article summarises the
> Australian ABF system as it was at the time and international experiences
> with performance incentives or penalties.
>
>
>
> At the time of writing (Jan 2013) I was of a similar view that such
> mechanisms were almost inevitable. The adoption of ABF systems at state
> level, introduction of NSQHS standards and increased use of CHADx groups
> (Aus developed Classification of Hospital Acquired Diagnoses) all suggest
> that were moving in the right direction towards greater accountability and
> non-payment for non-payment mechanisms. Unfortunately my experience at a
> ABF 2013 conference session with reluctance from states to embrace such
> mechanisms and the recently weakened position of the IHPA (Independent
> Hospital Pricing Authority) due to changes to the ABF system brought about
> by the 2014 budget make it seem unlikely in the foreseeable future.
>
>
>
> Its my view that a reduction in ALOS will continue to be the most
> compelling argument for investment in HAI prevention strategies for some
> time to come. Its a simple concept but with credit to Prof Stephen Duckett
> and the ABF 2013 conference for the slide, the current ABF system and
> payment based on DRG groups enables units to take any patient movement
> before the mean LOS (i.e. discharge between the low boundary inlier and
> mean) as a profit day by freeing up bed space for extra admissions.
>
>
>
> A favourite topic of mine so happy to chat offline if I can be of
> assistance!
>
>
>
> Kind regards,
>
>
>
> Robert
>
>
>
> *Robert Lansdown* | Product Manager
> *Teleflex Medical Australia & New Zealand*
> M: +61 448 115 274 | Customer Service: 1300 360 226 | W:
> http://www.teleflexmedical.com.au
>
> Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia
>
>
>
> —–Original Message—–
> From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU
> ] On Behalf Of Cath Murphy
> Sent: Sunday, 3 May 2015 8:41 AM
> To: AICALIST@AICALIST.ORG.AU
> Subject: Non-payment for non-performance and BSIs
>
>
>
> I have recently been asked about current financial incentives and
> disincentives related to bloodstream infection. Ducker and colleagues
> published some great articles around this issue about 2 years ago in MJA
> and suggested it was likely if not assured that hospital funding would soon
> be linked to performance data including HAIs and in particular BSIs. I have
> references if anyone is interested. This is reminiscent of the route the US
> Centers for Medicare and Medicaid adopted during my APIC Presidency.
>
>
>
> My understanding of this so far is that perhaps Queensland is the only
> state in which public hospitals are financially rewarded or penalised for
> being within or outside of BSI thresholds respectively. Could QLD members
> please confirm if this is the case and if so describe the incentive/
> penalty. I am also keen to here if other states have adopted or plan to
> adopt a similar approach for BSI and/or other HAIs.
>
>
>
> My understanding could be very flawed but I would appreciate insights and
> clarification around the process. I am happy to discuss the pros and cons
> of this approach and how APIC responded and the role it adopted offline, my
> contact details are below.
>
>
>
> Regards and thanks
>
> Cath
>
>
>
> Dr Cathryn Murphy RN MPH PhD CIC
>
> Executive Director
>
> Infection Control Plus Pty Ltd
>
> http://www.infectioncontrolplus.com.au
>
> Cath@infectioncontrolplus.com.au
>
>
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
> NOT REPRESENT THE OPINION OF ACIPC.
>
>
>
> The use of trade/product/commercial brand names through the list is
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> or services by brand or commercial names, please do this outside the list.
>
>
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> ______________________________________________________________________
> For the purposes of protecting the integrity and security of the SVHA
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> address on the svha.org.au domain (or any other domain of St Vincents
> Health Australia Limited or any of its related bodies corporate) (an SVHA
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> Click here
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> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO
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> The use of trade/product/commercial brand names through the list is
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> NOT REPRESENT THE OPINION OF ACIPC.
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> The use of trade/product/commercial brand names through the list is
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>
> Archive of all messages are available at http://aicalist.org.au/archives
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>—
*Claire Rickard **RN PhD FAAHMS FACN*
*Professor, NHMRC Centre of Research Excellence in Nursing Interventions,
Menzies Health Institute Queensland**Director, Alliance for Vascular Access Teaching and Research (AVATAR)*
*Visiting Scholar, Princess Alexandra, Prince Charles, and Royal Brisbane &
Women’s Hospitals*
*Honorary Professor, University of Manchester**Interested in IV research? http://www.avatargroup.org.au
**Follow the AVATAR Group*
*Interested in joining AVAS? http://www.avas.org.au *
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Here is some info on what Medibank Private has apparently done
Penalties Associated With ICU CLABSI Cases
Medibank, Australia’s largest private hospital insurer has agreements in place with more than 120 leading private hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.5 These include blood stream infections following infusion, transfusion and therapeutic injection.I am unable to comment on public sector.
1. https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
2. https://www.medibank.com.au/content/dam/medibank/calvary/medibank_hospital_acquired_complications_list_2015.pdfMy opinion for what it is worth is that this seems in other countries ie. the US to have seriously driven down reports of CLABSI. From a practical ICP point of view for me it would mean a very thorough and ongoing effort to ensure comprehensive, consistent best practice CL insertion, management with specific focus on skin preparation, aseptic insertion, placement, securement, dressing , hub access and protocols to prevent line failure. I am fortunate through my US experience to have seen widespread adoption of state of the art consumable equipment which assists these processes ie. CHG-impregnated dressings, impregnated cap swabbing devices, antimicrobial coated devices and skin preparation systems which reduce steps (ie. potential for error), have fingers placed far from the insertion site during preppring and standardise the practice of prepping. I think we are missing a CLABSI Technology bundle and it worries me greatly. Evidence exists in small numbers of various types of studies in various settings.
You may ask why am I so supportive of these interventions? Simply it’s because I am yet to see a global or national dataset that shows widespread, long-term 100% clinician compliance with hand hygiene, asepsis and appropriate hub access ie. our system of good manufacturing (GMP) for central-line management is imperfect and we need help and interventions to perfect it. Also I am now of an age and stage in life when friends and family are receiving more complex line-related healthcare and I am selfishly motivated for them and future healthcare consumers.
Finally it saddens me to think that financial disincentive rather than perhaps morbidity or mortality may ultimately drive better compliance and outcomes.
I apologise if this post reads like a passionate podium delivery and I suspect many will challenge my views but we have to keep the discourse open.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auCath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regardsSharon
Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au[cid:image005.png@01D0774C.C15F6A20]
Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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______________________________________________________________________
For the purposes of protecting the integrity and security of the SVHA network and the information held on it, all emails to and from any email address on the “svha.org.au” domain (or any other domain of St Vincent’s Health Australia Limited or any of its related bodies corporate) (an “SVHA Email Address”) will pass through and be scanned by the Symantec.cloud anti virus and anti spam filter service. These services may be provided by Symantec from locations outside of Australia and, if so, this will involve any email you send to or receive from an SVHA Email Address being sent to and scanned in those locations.Click here to report this email as spam.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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Hi Cath
Totally agree with your sentiments.
Does anyone know how this is impacting on private hospitals?
Obviously this all depends on correct ICD-10 coding so am wondering how many HAIs they list go undetected also with readmissions e.g last week we had a SABSI readmitted to a private hospital with source being a PJI- BCs done in a public ED and patient transfer to the private and no further BCs done so they would pick up on PJI but not the SABSI.I am quite intrigued how it all works!
Kindest Regards
Rebecca
Rebecca McCann Program Manager
Healthcare Associated Infection Unit (HAIU)
Communicable Disease Control Directorate Department of Health
Grace Vaughan House
227 Stubbs Terrace
SHENTON PARK WA 6008
T:08 9388 4859 M:0439 920 819 F:08 9388 4888
E:rebecca.mccann@health.wa.gov.auThe contents of this e-mail transmission are intended for the named recipients only and may contain confidential and/or privileged information. If you received this message in error, you must not copy, duplicate, forward, print or otherwise distribute any information contained herein, but must ensure that this e-mail is permanently deleted and advise the sender immediately.
Here is some info on what Medibank Private has apparently done
Penalties Associated With ICU CLABSI Cases
Medibank, Australias largest private hospital insurer has agreements in place with more than 120 leading private hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.5 These include blood stream infections following infusion, transfusion and therapeutic injection.I am unable to comment on public sector.
1. https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
2. https://www.medibank.com.au/content/dam/medibank/calvary/medibank_hospital_acquired_complications_list_2015.pdfMy opinion for what it is worth is that this seems in other countries ie. the US to have seriously driven down reports of CLABSI. From a practical ICP point of view for me it would mean a very thorough and ongoing effort to ensure comprehensive, consistent best practice CL insertion, management with specific focus on skin preparation, aseptic insertion, placement, securement, dressing , hub access and protocols to prevent line failure. I am fortunate through my US experience to have seen widespread adoption of state of the art consumable equipment which assists these processes ie. CHG-impregnated dressings, impregnated cap swabbing devices, antimicrobial coated devices and skin preparation systems which reduce steps (ie. potential for error), have fingers placed far from the insertion site during preppring and standardise the practice of prepping. I think we are missing a CLABSI Technology bundle and it worries me greatly. Evidence exists in small numbers of various types of studies in various settings.
You may ask why am I so supportive of these interventions? Simply its because I am yet to see a global or national dataset that shows widespread, long-term 100% clinician compliance with hand hygiene, asepsis and appropriate hub access ie. our system of good manufacturing (GMP) for central-line management is imperfect and we need help and interventions to perfect it. Also I am now of an age and stage in life when friends and family are receiving more complex line-related healthcare and I am selfishly motivated for them and future healthcare consumers.
Finally it saddens me to think that financial disincentive rather than perhaps morbidity or mortality may ultimately drive better compliance and outcomes.
I apologise if this post reads like a passionate podium delivery and I suspect many will challenge my views but we have to keep the discourse open.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auCath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regardsSharon
Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au[cid:image005.png@01D0774C.C15F6A20]
Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules Moderator]
Hi Cath,
Ive always taken a keen interest in funding mechanisms and in particular non-payment for non-performance mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that were moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
Its my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. Its a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a profit day by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
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______________________________________________________________________
For the purposes of protecting the integrity and security of the SVHA network and the information held on it, all emails to and from any email address on the svha.org.au domain (or any other domain of St Vincents Health Australia Limited or any of its related bodies corporate) (an SVHA Email Address) will pass through and be scanned by the Symantec.cloud anti virus and anti spam filter service. These services may be provided by Symantec from locations outside of Australia and, if so, this will involve any email you send to or receive from an SVHA Email Address being sent to and scanned in those locations.Click here to report this email as spam.
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https://www.paicap.org/index.html
This is an interesting US website that addresses Preventing Avoidable Infectious Complications by Adjusting Payment. Grace Lee from Harvard is one of the world leading authorities on this issue.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHere is some info on what Medibank Private has apparently done
Penalties Associated With ICU CLABSI Cases
Medibank, Australia’s largest private hospital insurer has agreements in place with more than 120 leading private hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.5 These include blood stream infections following infusion, transfusion and therapeutic injection.I am unable to comment on public sector.
1. https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
2. https://www.medibank.com.au/content/dam/medibank/calvary/medibank_hospital_acquired_complications_list_2015.pdfMy opinion for what it is worth is that this seems in other countries ie. the US to have seriously driven down reports of CLABSI. From a practical ICP point of view for me it would mean a very thorough and ongoing effort to ensure comprehensive, consistent best practice CL insertion, management with specific focus on skin preparation, aseptic insertion, placement, securement, dressing , hub access and protocols to prevent line failure. I am fortunate through my US experience to have seen widespread adoption of state of the art consumable equipment which assists these processes ie. CHG-impregnated dressings, impregnated cap swabbing devices, antimicrobial coated devices and skin preparation systems which reduce steps (ie. potential for error), have fingers placed far from the insertion site during preppring and standardise the practice of prepping. I think we are missing a CLABSI Technology bundle and it worries me greatly. Evidence exists in small numbers of various types of studies in various settings.
You may ask why am I so supportive of these interventions? Simply it’s because I am yet to see a global or national dataset that shows widespread, long-term 100% clinician compliance with hand hygiene, asepsis and appropriate hub access ie. our system of good manufacturing (GMP) for central-line management is imperfect and we need help and interventions to perfect it. Also I am now of an age and stage in life when friends and family are receiving more complex line-related healthcare and I am selfishly motivated for them and future healthcare consumers.
Finally it saddens me to think that financial disincentive rather than perhaps morbidity or mortality may ultimately drive better compliance and outcomes.
I apologise if this post reads like a passionate podium delivery and I suspect many will challenge my views but we have to keep the discourse open.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auCath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regardsSharon
Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au[cid:image005.png@01D0774C.C15F6A20]
Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
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______________________________________________________________________
For the purposes of protecting the integrity and security of the SVHA network and the information held on it, all emails to and from any email address on the “svha.org.au” domain (or any other domain of St Vincent’s Health Australia Limited or any of its related bodies corporate) (an “SVHA Email Address”) will pass through and be scanned by the Symantec.cloud anti virus and anti spam filter service. These services may be provided by Symantec from locations outside of Australia and, if so, this will involve any email you send to or receive from an SVHA Email Address being sent to and scanned in those locations.Click here to report this email as spam.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
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Hi Cath
You know I am also passionate about reducing the preventable healthcare infection burden, but I just wanted to debate some of the ‘technology consumables’ in a standard bundle approach.
Yes, we should all ensure that insertion and management of central lines is standardised, but the actual role of some technology solutions such as chlorhexidine impregnated dressings and devices, and impregnated access device caps for management, as just two examples of available technology, is still very much debatable, in my opinion, in management of all central lines.
We can throw money and resources into technological solutions, but are we really getting the ‘best bang for our buck’ with our healthcare spending by doing this? There needs to be better evidence to base these choices on, and groups like Claire Rickard’s vascular access research group with large multicentre trials will hopefully start providing some answers to these questions in the future. But to promote using these technological solutions for all central line management (eg ‘bundle approach’), is premature in my opinion. Unless I have misinterpreted what you are proposing.
In the private sector, we are already facing issues with the private health funds in regard to what they are saying is ‘preventable’. Most of their current systems are based on coding, and we all know how well clinical codes reflect the infection risk and preventability. I welcome debate about how we can reduce the risk of preventable infections, and feel the professional bodies such as ACIPC and ASID should have a role to play in developing criteria to be used by funding bodies. Maybe our professional association should be lobbying on behalf of the members for this to be discussed.
All my opinion only, of course.
Cheers
MichaelMichael Wishart
Infection Control CoordinatorA 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D01926.61F1C2B0]
P Please consider the environment before printing this emailHere is some info on what Medibank Private has apparently done
Penalties Associated With ICU CLABSI Cases
Medibank, Australia’s largest private hospital insurer has agreements in place with more than 120 leading private hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.5 These include blood stream infections following infusion, transfusion and therapeutic injection.I am unable to comment on public sector.
1. https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
2. https://www.medibank.com.au/content/dam/medibank/calvary/medibank_hospital_acquired_complications_list_2015.pdfMy opinion for what it is worth is that this seems in other countries ie. the US to have seriously driven down reports of CLABSI. From a practical ICP point of view for me it would mean a very thorough and ongoing effort to ensure comprehensive, consistent best practice CL insertion, management with specific focus on skin preparation, aseptic insertion, placement, securement, dressing , hub access and protocols to prevent line failure. I am fortunate through my US experience to have seen widespread adoption of state of the art consumable equipment which assists these processes ie. CHG-impregnated dressings, impregnated cap swabbing devices, antimicrobial coated devices and skin preparation systems which reduce steps (ie. potential for error), have fingers placed far from the insertion site during preppring and standardise the practice of prepping. I think we are missing a CLABSI Technology bundle and it worries me greatly. Evidence exists in small numbers of various types of studies in various settings.
You may ask why am I so supportive of these interventions? Simply it’s because I am yet to see a global or national dataset that shows widespread, long-term 100% clinician compliance with hand hygiene, asepsis and appropriate hub access ie. our system of good manufacturing (GMP) for central-line management is imperfect and we need help and interventions to perfect it. Also I am now of an age and stage in life when friends and family are receiving more complex line-related healthcare and I am selfishly motivated for them and future healthcare consumers.
Finally it saddens me to think that financial disincentive rather than perhaps morbidity or mortality may ultimately drive better compliance and outcomes.
I apologise if this post reads like a passionate podium delivery and I suspect many will challenge my views but we have to keep the discourse open.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auCath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regardsSharon
Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au[cid:image005.png@01D0774C.C15F6A20]
Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
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Hi Cath and Michael
The Clinical Excellence Commission undertook a CLABSI prevention bundle project (Burrell A, et al. Aseptic insertion of central lines reduces bacteraemia. Med J Aust 2011; 194 (11): 583-587.) using the Pronovost Bundle and it was so successful that it was rolled out by ANZICS to all ICUs across Australia. I accept that ICUs is not the source for all CLABSI but our review of where the Insertion Bundle worked found that for the first 9 days of dwell time if a central line is inserted with full aseptic technique then it remains uninfected, mostly (McLaws ML, Burrell A. Zero-risk for Central Line Associated Bloodstream Infection: Are we there yet? Crit Care Med 2012 Feb;40(2):388-93.)
Where a Technology Bundle would improve patient safety is for patients expected to have a dwell time >9 days. This may need a crystal ball but these patients benefit from the aseptic insertion for the first 9 days but then risk rises dramatically and they need additional assistance (perhaps from the Technology Bundle as well as an aseptic management/access approach for HCWs).
M-L
Professor Mary-Louise McLaws
Professor of Epidemiology Healthcare Infection and Infectious Diseases Control
Academic Board Member
UNSW Higher Research Degrees Committee Member
UNSW Instititue of Water lead on Health & Water
UNSW Medicine, UNSW, SYDNEY NSW 2052 AUSTRALIA
T: +61 2 93852586
UNSW ABN 57195873179 CRICOS Provider Code 00098G
________________________________Hi Cath
You know I am also passionate about reducing the preventable healthcare infection burden, but I just wanted to debate some of the ‘technology consumables’ in a standard bundle approach.
Yes, we should all ensure that insertion and management of central lines is standardised, but the actual role of some technology solutions such as chlorhexidine impregnated dressings and devices, and impregnated access device caps for management, as just two examples of available technology, is still very much debatable, in my opinion, in management of all central lines.
We can throw money and resources into technological solutions, but are we really getting the ‘best bang for our buck’ with our healthcare spending by doing this? There needs to be better evidence to base these choices on, and groups like Claire Rickard’s vascular access research group with large multicentre trials will hopefully start providing some answers to these questions in the future. But to promote using these technological solutions for all central line management (eg ‘bundle approach’), is premature in my opinion. Unless I have misinterpreted what you are proposing.
In the private sector, we are already facing issues with the private health funds in regard to what they are saying is ‘preventable’. Most of their current systems are based on coding, and we all know how well clinical codes reflect the infection risk and preventability. I welcome debate about how we can reduce the risk of preventable infections, and feel the professional bodies such as ACIPC and ASID should have a role to play in developing criteria to be used by funding bodies. Maybe our professional association should be lobbying on behalf of the members for this to be discussed.
All my opinion only, of course.
Cheers
MichaelMichael Wishart
Infection Control CoordinatorA 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D01926.61F1C2B0]
P Please consider the environment before printing this emailHere is some info on what Medibank Private has apparently done
Penalties Associated With ICU CLABSI Cases
Medibank, Australia’s largest private hospital insurer has agreements in place with more than 120 leading private hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.5 These include blood stream infections following infusion, transfusion and therapeutic injection.I am unable to comment on public sector.
1. https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
2. https://www.medibank.com.au/content/dam/medibank/calvary/medibank_hospital_acquired_complications_list_2015.pdfMy opinion for what it is worth is that this seems in other countries ie. the US to have seriously driven down reports of CLABSI. From a practical ICP point of view for me it would mean a very thorough and ongoing effort to ensure comprehensive, consistent best practice CL insertion, management with specific focus on skin preparation, aseptic insertion, placement, securement, dressing , hub access and protocols to prevent line failure. I am fortunate through my US experience to have seen widespread adoption of state of the art consumable equipment which assists these processes ie. CHG-impregnated dressings, impregnated cap swabbing devices, antimicrobial coated devices and skin preparation systems which reduce steps (ie. potential for error), have fingers placed far from the insertion site during preppring and standardise the practice of prepping. I think we are missing a CLABSI Technology bundle and it worries me greatly. Evidence exists in small numbers of various types of studies in various settings.
You may ask why am I so supportive of these interventions? Simply it’s because I am yet to see a global or national dataset that shows widespread, long-term 100% clinician compliance with hand hygiene, asepsis and appropriate hub access ie. our system of good manufacturing (GMP) for central-line management is imperfect and we need help and interventions to perfect it. Also I am now of an age and stage in life when friends and family are receiving more complex line-related healthcare and I am selfishly motivated for them and future healthcare consumers.
Finally it saddens me to think that financial disincentive rather than perhaps morbidity or mortality may ultimately drive better compliance and outcomes.
I apologise if this post reads like a passionate podium delivery and I suspect many will challenge my views but we have to keep the discourse open.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auCath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regardsSharon
Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au[cid:image005.png@01D0774C.C15F6A20]
Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
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Thanks Michael
Debate is healthy and considered review of emerging additional proven technologies is as you and I agree one aspect of HAI prevention. What I am hoping to do is provoke discussion, raise awareness and discourse. Infection control is a very hard role and a very frustrating one but clearly there is lots of room for innovation, consideration of new approaches including improved practice and technologies and monitoring and education. Financial penalty is a new driver and responses remind me of those responses and resistance we had in the early 1990s when pioneers like you and others of us around that long called for public reporting of HAIs. Look how far we have come and think about how much further we can go, in fact we have to go, in terms of prevention.
We are very fortunate in Australia to have some cutting edge researchers investigating all sorts of HAI interventions and outcomes and yes there will always be those who are premature and those that are laggards. I hope when I am cared for it is by a facility that is progressive as well as economically rationale in their infection prevention investment. Having good progressive public policy and practice also helps.
Cheers
CathHi Cath
You know I am also passionate about reducing the preventable healthcare infection burden, but I just wanted to debate some of the ‘technology consumables’ in a standard bundle approach.
Yes, we should all ensure that insertion and management of central lines is standardised, but the actual role of some technology solutions such as chlorhexidine impregnated dressings and devices, and impregnated access device caps for management, as just two examples of available technology, is still very much debatable, in my opinion, in management of all central lines.
We can throw money and resources into technological solutions, but are we really getting the ‘best bang for our buck’ with our healthcare spending by doing this? There needs to be better evidence to base these choices on, and groups like Claire Rickard’s vascular access research group with large multicentre trials will hopefully start providing some answers to these questions in the future. But to promote using these technological solutions for all central line management (eg ‘bundle approach’), is premature in my opinion. Unless I have misinterpreted what you are proposing.
In the private sector, we are already facing issues with the private health funds in regard to what they are saying is ‘preventable’. Most of their current systems are based on coding, and we all know how well clinical codes reflect the infection risk and preventability. I welcome debate about how we can reduce the risk of preventable infections, and feel the professional bodies such as ACIPC and ASID should have a role to play in developing criteria to be used by funding bodies. Maybe our professional association should be lobbying on behalf of the members for this to be discussed.
All my opinion only, of course.
Cheers
MichaelMichael Wishart
Infection Control CoordinatorA 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D01926.61F1C2B0]
P Please consider the environment before printing this emailHere is some info on what Medibank Private has apparently done
Penalties Associated With ICU CLABSI Cases
Medibank, Australia’s largest private hospital insurer has agreements in place with more than 120 leading private hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.5 These include blood stream infections following infusion, transfusion and therapeutic injection.I am unable to comment on public sector.
1. https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
2. https://www.medibank.com.au/content/dam/medibank/calvary/medibank_hospital_acquired_complications_list_2015.pdfMy opinion for what it is worth is that this seems in other countries ie. the US to have seriously driven down reports of CLABSI. From a practical ICP point of view for me it would mean a very thorough and ongoing effort to ensure comprehensive, consistent best practice CL insertion, management with specific focus on skin preparation, aseptic insertion, placement, securement, dressing , hub access and protocols to prevent line failure. I am fortunate through my US experience to have seen widespread adoption of state of the art consumable equipment which assists these processes ie. CHG-impregnated dressings, impregnated cap swabbing devices, antimicrobial coated devices and skin preparation systems which reduce steps (ie. potential for error), have fingers placed far from the insertion site during preppring and standardise the practice of prepping. I think we are missing a CLABSI Technology bundle and it worries me greatly. Evidence exists in small numbers of various types of studies in various settings.
You may ask why am I so supportive of these interventions? Simply it’s because I am yet to see a global or national dataset that shows widespread, long-term 100% clinician compliance with hand hygiene, asepsis and appropriate hub access ie. our system of good manufacturing (GMP) for central-line management is imperfect and we need help and interventions to perfect it. Also I am now of an age and stage in life when friends and family are receiving more complex line-related healthcare and I am selfishly motivated for them and future healthcare consumers.
Finally it saddens me to think that financial disincentive rather than perhaps morbidity or mortality may ultimately drive better compliance and outcomes.
I apologise if this post reads like a passionate podium delivery and I suspect many will challenge my views but we have to keep the discourse open.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auCath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regardsSharon
Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au[cid:image005.png@01D0774C.C15F6A20]
Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
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Hi Cath et al,
This topic I find interesting on many levels due to the economics, public health impacts advancing technology.
Healthcare bundles utilised by healthcare workers can improve patient outcome and are evidenced by research. I have utilised many bundles with my background in adult ICU and IPAC nursing both in the UK private sector and Australian public health systemsA slight Segway off the topic of Non-payment for non-performance and BSI but a worth considering is the behaviour of HCWs.
Having relieved the Parenteral Nutrition CNC position over time and having discharged patients home with invasive lines for them to receive TPN that I have not come across a CLABSI within this patient population during surveillance.
That is not to say it doesn’t or hasn’t occurred. Patient/carer need to be assessed as competent with invasive line care: dressing changes, accessing and de-accessing, setting up infusions, flushing and locking lumens prior to discharge.
Ultimately a ‘Standard Precautions, Aseptic Technique and Hand Hygiene Bundle” of education and competency assessment is delivered the patient/carer to care for lines that are used for many years.I find it interesting a patient/carer from a non-health care background can use these principles successfully – however trained HCWs require bundles.
Regards,
Sharyn
Sharyn Hughes
Clinical Nurse Consultant |Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264490Click here Infection Prevention and Control to visit the IPAC webpage
Thanks Michael
Debate is healthy and considered review of emerging additional proven technologies is as you and I agree one aspect of HAI prevention. What I am hoping to do is provoke discussion, raise awareness and discourse. Infection control is a very hard role and a very frustrating one but clearly there is lots of room for innovation, consideration of new approaches including improved practice and technologies and monitoring and education. Financial penalty is a new driver and responses remind me of those responses and resistance we had in the early 1990s when pioneers like you and others of us around that long called for public reporting of HAIs. Look how far we have come and think about how much further we can go, in fact we have to go, in terms of prevention.
We are very fortunate in Australia to have some cutting edge researchers investigating all sorts of HAI interventions and outcomes and yes there will always be those who are premature and those that are laggards. I hope when I am cared for it is by a facility that is progressive as well as economically rationale in their infection prevention investment. Having good progressive public policy and practice also helps.
Cheers
CathHi Cath
You know I am also passionate about reducing the preventable healthcare infection burden, but I just wanted to debate some of the ‘technology consumables’ in a standard bundle approach.
Yes, we should all ensure that insertion and management of central lines is standardised, but the actual role of some technology solutions such as chlorhexidine impregnated dressings and devices, and impregnated access device caps for management, as just two examples of available technology, is still very much debatable, in my opinion, in management of all central lines.
We can throw money and resources into technological solutions, but are we really getting the ‘best bang for our buck’ with our healthcare spending by doing this? There needs to be better evidence to base these choices on, and groups like Claire Rickard’s vascular access research group with large multicentre trials will hopefully start providing some answers to these questions in the future. But to promote using these technological solutions for all central line management (eg ‘bundle approach’), is premature in my opinion. Unless I have misinterpreted what you are proposing.
In the private sector, we are already facing issues with the private health funds in regard to what they are saying is ‘preventable’. Most of their current systems are based on coding, and we all know how well clinical codes reflect the infection risk and preventability. I welcome debate about how we can reduce the risk of preventable infections, and feel the professional bodies such as ACIPC and ASID should have a role to play in developing criteria to be used by funding bodies. Maybe our professional association should be lobbying on behalf of the members for this to be discussed.
All my opinion only, of course.
Cheers
MichaelMichael Wishart
Infection Control CoordinatorA 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D01926.61F1C2B0]
P Please consider the environment before printing this emailHere is some info on what Medibank Private has apparently done
Penalties Associated With ICU CLABSI Cases
Medibank, Australia’s largest private hospital insurer has agreements in place with more than 120 leading private hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.5 These include blood stream infections following infusion, transfusion and therapeutic injection.I am unable to comment on public sector.
1. https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
2. https://www.medibank.com.au/content/dam/medibank/calvary/medibank_hospital_acquired_complications_list_2015.pdfMy opinion for what it is worth is that this seems in other countries ie. the US to have seriously driven down reports of CLABSI. From a practical ICP point of view for me it would mean a very thorough and ongoing effort to ensure comprehensive, consistent best practice CL insertion, management with specific focus on skin preparation, aseptic insertion, placement, securement, dressing , hub access and protocols to prevent line failure. I am fortunate through my US experience to have seen widespread adoption of state of the art consumable equipment which assists these processes ie. CHG-impregnated dressings, impregnated cap swabbing devices, antimicrobial coated devices and skin preparation systems which reduce steps (ie. potential for error), have fingers placed far from the insertion site during preppring and standardise the practice of prepping. I think we are missing a CLABSI Technology bundle and it worries me greatly. Evidence exists in small numbers of various types of studies in various settings.
You may ask why am I so supportive of these interventions? Simply it’s because I am yet to see a global or national dataset that shows widespread, long-term 100% clinician compliance with hand hygiene, asepsis and appropriate hub access ie. our system of good manufacturing (GMP) for central-line management is imperfect and we need help and interventions to perfect it. Also I am now of an age and stage in life when friends and family are receiving more complex line-related healthcare and I am selfishly motivated for them and future healthcare consumers.
Finally it saddens me to think that financial disincentive rather than perhaps morbidity or mortality may ultimately drive better compliance and outcomes.
I apologise if this post reads like a passionate podium delivery and I suspect many will challenge my views but we have to keep the discourse open.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auCath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regardsSharon
Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au[cid:image005.png@01D0774C.C15F6A20]
Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
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Motivation is powerful Sharyn. Preservation and self-preservation are sometimes even more powerful. Would make for a very interesting ethnographic PhD. Thank you for raising it.
Cheers
CathHi Cath et al,
This topic I find interesting on many levels due to the economics, public health impacts advancing technology.
Healthcare bundles utilised by healthcare workers can improve patient outcome and are evidenced by research. I have utilised many bundles with my background in adult ICU and IPAC nursing both in the UK private sector and Australian public health systemsA slight Segway off the topic of Non-payment for non-performance and BSI but a worth considering is the behaviour of HCWs.
Having relieved the Parenteral Nutrition CNC position over time and having discharged patients home with invasive lines for them to receive TPN that I have not come across a CLABSI within this patient population during surveillance.
That is not to say it doesn’t or hasn’t occurred. Patient/carer need to be assessed as competent with invasive line care: dressing changes, accessing and de-accessing, setting up infusions, flushing and locking lumens prior to discharge.
Ultimately a ‘Standard Precautions, Aseptic Technique and Hand Hygiene Bundle” of education and competency assessment is delivered the patient/carer to care for lines that are used for many years.I find it interesting a patient/carer from a non-health care background can use these principles successfully – however trained HCWs require bundles.
Regards,
Sharyn
Sharyn Hughes
Clinical Nurse Consultant |Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264490Click here Infection Prevention and Control to visit the IPAC webpage
Thanks Michael
Debate is healthy and considered review of emerging additional proven technologies is as you and I agree one aspect of HAI prevention. What I am hoping to do is provoke discussion, raise awareness and discourse. Infection control is a very hard role and a very frustrating one but clearly there is lots of room for innovation, consideration of new approaches including improved practice and technologies and monitoring and education. Financial penalty is a new driver and responses remind me of those responses and resistance we had in the early 1990s when pioneers like you and others of us around that long called for public reporting of HAIs. Look how far we have come and think about how much further we can go, in fact we have to go, in terms of prevention.
We are very fortunate in Australia to have some cutting edge researchers investigating all sorts of HAI interventions and outcomes and yes there will always be those who are premature and those that are laggards. I hope when I am cared for it is by a facility that is progressive as well as economically rationale in their infection prevention investment. Having good progressive public policy and practice also helps.
Cheers
CathHi Cath
You know I am also passionate about reducing the preventable healthcare infection burden, but I just wanted to debate some of the ‘technology consumables’ in a standard bundle approach.
Yes, we should all ensure that insertion and management of central lines is standardised, but the actual role of some technology solutions such as chlorhexidine impregnated dressings and devices, and impregnated access device caps for management, as just two examples of available technology, is still very much debatable, in my opinion, in management of all central lines.
We can throw money and resources into technological solutions, but are we really getting the ‘best bang for our buck’ with our healthcare spending by doing this? There needs to be better evidence to base these choices on, and groups like Claire Rickard’s vascular access research group with large multicentre trials will hopefully start providing some answers to these questions in the future. But to promote using these technological solutions for all central line management (eg ‘bundle approach’), is premature in my opinion. Unless I have misinterpreted what you are proposing.
In the private sector, we are already facing issues with the private health funds in regard to what they are saying is ‘preventable’. Most of their current systems are based on coding, and we all know how well clinical codes reflect the infection risk and preventability. I welcome debate about how we can reduce the risk of preventable infections, and feel the professional bodies such as ACIPC and ASID should have a role to play in developing criteria to be used by funding bodies. Maybe our professional association should be lobbying on behalf of the members for this to be discussed.
All my opinion only, of course.
Cheers
MichaelMichael Wishart
Infection Control CoordinatorA 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.png@01D01926.61F1C2B0]
P Please consider the environment before printing this emailHere is some info on what Medibank Private has apparently done
Penalties Associated With ICU CLABSI Cases
Medibank, Australia’s largest private hospital insurer has agreements in place with more than 120 leading private hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.5 These include blood stream infections following infusion, transfusion and therapeutic injection.I am unable to comment on public sector.
1. https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
2. https://www.medibank.com.au/content/dam/medibank/calvary/medibank_hospital_acquired_complications_list_2015.pdfMy opinion for what it is worth is that this seems in other countries ie. the US to have seriously driven down reports of CLABSI. From a practical ICP point of view for me it would mean a very thorough and ongoing effort to ensure comprehensive, consistent best practice CL insertion, management with specific focus on skin preparation, aseptic insertion, placement, securement, dressing , hub access and protocols to prevent line failure. I am fortunate through my US experience to have seen widespread adoption of state of the art consumable equipment which assists these processes ie. CHG-impregnated dressings, impregnated cap swabbing devices, antimicrobial coated devices and skin preparation systems which reduce steps (ie. potential for error), have fingers placed far from the insertion site during preppring and standardise the practice of prepping. I think we are missing a CLABSI Technology bundle and it worries me greatly. Evidence exists in small numbers of various types of studies in various settings.
You may ask why am I so supportive of these interventions? Simply it’s because I am yet to see a global or national dataset that shows widespread, long-term 100% clinician compliance with hand hygiene, asepsis and appropriate hub access ie. our system of good manufacturing (GMP) for central-line management is imperfect and we need help and interventions to perfect it. Also I am now of an age and stage in life when friends and family are receiving more complex line-related healthcare and I am selfishly motivated for them and future healthcare consumers.
Finally it saddens me to think that financial disincentive rather than perhaps morbidity or mortality may ultimately drive better compliance and outcomes.
I apologise if this post reads like a passionate podium delivery and I suspect many will challenge my views but we have to keep the discourse open.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auCath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regardsSharon
Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au[cid:image005.png@01D0774C.C15F6A20]
Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
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Cath
Thanks for starting the conversation, considering the input from all, this is something that is near and dear to all of us.
Re your original question about counting and reporting on CLABSI, yes there is lots of information in the ICU setting, yet my experience is that is nothing for the non ICU setting. For our HHS we report our CLABSIs locally using bed day data. This is supported by Horstman, M. J., et al. (2015). “Denominator Doesn’t Matter: Standardizing Healthcare-Associated Infection Rates by Bed Days or Device Days.” Infection Control & Hospital Epidemiology 36(6): 710-716.
Our data is also reported up through the enterprise reporting systems used across QH. Where it goes from there? Or if it indeed goes anywhere, is something of a common concern for all ICPs. How do we truly know how we are doing if we can’t see ourselves against other like facilities. While CLABSI does have significant morbidity and mortality, with no reporting of other reasons for central venous access device (CVAD) failure; which have significant impacts on Patient safety and satisfaction – how can we ever improve the patient experience and prevent harm form occurring?
Results of a recent vascular access device(VAD) audit for my facility identified that these devices can be found in any inpatient ward including low acuity rehabilitation beds. CVADS were present in 14% of the entire patient population (263). In this group 61% were found to have some type of vascular access device, just under of all patients with a VAD had a CVAD. So we need to move from concentrating on ICU CLABSI rates, to what is happing in the rest of the facility.
Re the subject of a bundle for care and maintenance – I will leave for another day. I look forward to seeing where this conversation leads us.
Thanks
Mandy Davidson
RN DipPHTM MPHTM JCU
CNC Infection Prevention & Control
Townsville Hospital & Health Service
Pathology Building
IMB 38
P: 4433 3567
Mandy.Davidson@health.qld.gov.au
[cid:image001.jpg@01D20435.7BE4B690]Motivation is powerful Sharyn. Preservation and self-preservation are sometimes even more powerful. Would make for a very interesting ethnographic PhD. Thank you for raising it.
Cheers
CathHi Cath et al,
This topic I find interesting on many levels due to the economics, public health impacts advancing technology.
Healthcare bundles utilised by healthcare workers can improve patient outcome and are evidenced by research. I have utilised many bundles with my background in adult ICU and IPAC nursing both in the UK private sector and Australian public health systemsA slight Segway off the topic of Non-payment for non-performance and BSI but a worth considering is the behaviour of HCWs.
Having relieved the Parenteral Nutrition CNC position over time and having discharged patients home with invasive lines for them to receive TPN that I have not come across a CLABSI within this patient population during surveillance.
That is not to say it doesn’t or hasn’t occurred. Patient/carer need to be assessed as competent with invasive line care: dressing changes, accessing and de-accessing, setting up infusions, flushing and locking lumens prior to discharge.
Ultimately a ‘Standard Precautions, Aseptic Technique and Hand Hygiene Bundle” of education and competency assessment is delivered the patient/carer to care for lines that are used for many years.I find it interesting a patient/carer from a non-health care background can use these principles successfully – however trained HCWs require bundles.
Regards,
Sharyn
Sharyn Hughes
Clinical Nurse Consultant |Infection Prevention & Control
Royal North Shore Hospital
Reserve Rd St Leonards 2065
Tel 02 99264490Click here Infection Prevention and Control to visit the IPAC webpage
Thanks Michael
Debate is healthy and considered review of emerging additional proven technologies is as you and I agree one aspect of HAI prevention. What I am hoping to do is provoke discussion, raise awareness and discourse. Infection control is a very hard role and a very frustrating one but clearly there is lots of room for innovation, consideration of new approaches including improved practice and technologies and monitoring and education. Financial penalty is a new driver and responses remind me of those responses and resistance we had in the early 1990s when pioneers like you and others of us around that long called for public reporting of HAIs. Look how far we have come and think about how much further we can go, in fact we have to go, in terms of prevention.
We are very fortunate in Australia to have some cutting edge researchers investigating all sorts of HAI interventions and outcomes and yes there will always be those who are premature and those that are laggards. I hope when I am cared for it is by a facility that is progressive as well as economically rationale in their infection prevention investment. Having good progressive public policy and practice also helps.
Cheers
CathHi Cath
You know I am also passionate about reducing the preventable healthcare infection burden, but I just wanted to debate some of the ‘technology consumables’ in a standard bundle approach.
Yes, we should all ensure that insertion and management of central lines is standardised, but the actual role of some technology solutions such as chlorhexidine impregnated dressings and devices, and impregnated access device caps for management, as just two examples of available technology, is still very much debatable, in my opinion, in management of all central lines.
We can throw money and resources into technological solutions, but are we really getting the ‘best bang for our buck’ with our healthcare spending by doing this? There needs to be better evidence to base these choices on, and groups like Claire Rickard’s vascular access research group with large multicentre trials will hopefully start providing some answers to these questions in the future. But to promote using these technological solutions for all central line management (eg ‘bundle approach’), is premature in my opinion. Unless I have misinterpreted what you are proposing.
In the private sector, we are already facing issues with the private health funds in regard to what they are saying is ‘preventable’. Most of their current systems are based on coding, and we all know how well clinical codes reflect the infection risk and preventability. I welcome debate about how we can reduce the risk of preventable infections, and feel the professional bodies such as ACIPC and ASID should have a role to play in developing criteria to be used by funding bodies. Maybe our professional association should be lobbying on behalf of the members for this to be discussed.
All my opinion only, of course.
Cheers
MichaelMichael Wishart
Infection Control CoordinatorA 627 Rode Road, Chermside QLD 4032
P (07) 3326 3068 | F (07) 3607 2226 | E michael.wishart@svha.org.au | W http://www.hsnph.org.au
[cid:image001.gif@01D20391.F3920520]
P Please consider the environment before printing this emailHere is some info on what Medibank Private has apparently done
Penalties Associated With ICU CLABSI Cases
Medibank, Australia’s largest private hospital insurer has agreements in place with more than 120 leading private hospitals to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.5 These include blood stream infections following infusion, transfusion and therapeutic injection.I am unable to comment on public sector.
1. https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
2. https://www.medibank.com.au/content/dam/medibank/calvary/medibank_hospital_acquired_complications_list_2015.pdfMy opinion for what it is worth is that this seems in other countries ie. the US to have seriously driven down reports of CLABSI. From a practical ICP point of view for me it would mean a very thorough and ongoing effort to ensure comprehensive, consistent best practice CL insertion, management with specific focus on skin preparation, aseptic insertion, placement, securement, dressing , hub access and protocols to prevent line failure. I am fortunate through my US experience to have seen widespread adoption of state of the art consumable equipment which assists these processes ie. CHG-impregnated dressings, impregnated cap swabbing devices, antimicrobial coated devices and skin preparation systems which reduce steps (ie. potential for error), have fingers placed far from the insertion site during preppring and standardise the practice of prepping. I think we are missing a CLABSI Technology bundle and it worries me greatly. Evidence exists in small numbers of various types of studies in various settings.
You may ask why am I so supportive of these interventions? Simply it’s because I am yet to see a global or national dataset that shows widespread, long-term 100% clinician compliance with hand hygiene, asepsis and appropriate hub access ie. our system of good manufacturing (GMP) for central-line management is imperfect and we need help and interventions to perfect it. Also I am now of an age and stage in life when friends and family are receiving more complex line-related healthcare and I am selfishly motivated for them and future healthcare consumers.
Finally it saddens me to think that financial disincentive rather than perhaps morbidity or mortality may ultimately drive better compliance and outcomes.
I apologise if this post reads like a passionate podium delivery and I suspect many will challenge my views but we have to keep the discourse open.
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auCath,
Have they made the list of hospital complication or associated re-admissions public?
Would be interesting to see what HCAI are on it.
Kind regardsSharon
Sharon Stendt
Clinical Practice Consultant Infection Prevention and Control
Flinders Medical Centre Infection Control Service
Telephone 8204 6787
Internal extension 66787
Messagebank 65258 / 8204 5258
sharon.stendt@sa.gov.au[cid:image001.png@01D2029B.77BB8490]
Here is the companion old chestnut question that goes with better public reporting.
Is any state aware of new penalties introduced for public hospitals?
I am aware of Medibank contractual obligations with more than 120 of its private hospitals not to cover any additional costs that result from certain types of hospital complication or associated re-admissions where there is good evidence that these types of complication could be reduced or avoided.
Is the public sector still tolerating CLABSIs without penalty?
https://www.medibank.com.au/content/about/transforming-health/hospital-contracts.html
Warm regards
CathCathryn Murphy MPH PhD CIC
Chief Executive Officer & Creative Director
Infection Control Plus Pty Ltd
PO Box 3079
Burleigh Town 4220
OLD, AustraliaE: Cath@infectioncontrolplus.com.au
M: +61 428 154154
W: infectioncontrolplus.com.auHi Michael and Cath,
Very interest topic. It is also worth noting the value of released bed days from infections prevented. There are some good papers on this, including one by Andrew Stewardson, Nicholas Graves and Stephan Harbarth – http://journals.cambridge.org/action/displayAbstract?fromPageonline&aid9497698&fileIdS0195941700094418
You may be interested to hear that this theme and variations thereof, are being explored in ACIPC conference this year. Andrew, Nick and Stephan are presenting at this conference. There is also a moderated discussion being led by an ABC presenter which will discuss the merits and issues in a similar theme to the one raised. This discussion with include the CEO of the NHPA. More on this to come……
Going to the point of LOS, as you will both know, it is critical such calculations of excess LOS due to an infection are done correctly. All too often the wrong analysis is undertaken. Adrian Barnett will be talking about this during the conference as well.
Thanks
Brett
Associate Professor Brett Mitchell
Associate Professor of Nursing, RN, BN, PhD, M.Adv.Prac, CICP, MRCNA
Faculty of Nursing and Health and Director Lifestyle Research Centre, CooranbongAvondale College Ltd trading as Avondale College of Higher Education
http://www.avondale.edu.au | http://www.designedforlife.me
185 Fox Valley Road, Wahroonga NSW 2076 Australia[Posted on behalf of Robert Lansdown, advertising material removed as per Rules – Moderator]
Hi Cath,
I’ve always taken a keen interest in funding mechanisms and in particular ‘non-payment for non-performance’ mechanisms for HAIs and I researched the topic fairly extensively back in early 2013 prior to writing the attached article for our IPH Advisor newsletter (as Mayo Healthcare before our transformation to Teleflex Medical Australia). The article summarises the Australian ABF system as it was at the time and international experiences with performance incentives or penalties.
At the time of writing (Jan 2013) I was of a similar view that such mechanisms were almost inevitable. The adoption of ABF systems at state level, introduction of NSQHS standards and increased use of CHADx groups (Aus developed Classification of Hospital Acquired Diagnoses) all suggest that we’re moving in the right direction towards greater accountability and non-payment for non-payment mechanisms. Unfortunately my experience at a ABF 2013 conference session with reluctance from states to embrace such mechanisms and the recently weakened position of the IHPA (Independent Hospital Pricing Authority) due to changes to the ABF system brought about by the 2014 budget make it seem unlikely in the foreseeable future.
It’s my view that a reduction in ALOS will continue to be the most compelling argument for investment in HAI prevention strategies for some time to come. It’s a simple concept but with credit to Prof Stephen Duckett and the ABF 2013 conference for the slide, the current ABF system and payment based on DRG groups enables units to take any patient movement before the mean LOS (i.e. discharge between the low boundary inlier and mean) as a ‘profit day’ by freeing up bed space for extra admissions.
A favourite topic of mine so happy to chat offline if I can be of assistance!
Kind regards,
Robert
Robert Lansdown | Product Manager
Teleflex Medical Australia & New Zealand
M: +61 448 115 274 | Customer Service: 1300 360 226 | W: http://www.teleflexmedical.com.au
Building B, Level 4 – 201 Coward Street, Mascot NSW, 2020, Australia—–Original Message—–
I have recently been asked about current financial incentives and disincentives related to bloodstream infection. Ducker and colleagues published some great articles around this issue about 2 years ago in MJA and suggested it was likely if not assured that hospital funding would soon be linked to performance data including HAIs and in particular BSIs. I have references if anyone is interested. This is reminiscent of the route the US Centers for Medicare and Medicaid adopted during my APIC Presidency.
My understanding of this so far is that perhaps Queensland is the only state in which public hospitals are financially rewarded or penalised for being within or outside of BSI thresholds respectively. Could QLD members please confirm if this is the case and if so describe the incentive/ penalty. I am also keen to here if other states have adopted or plan to adopt a similar approach for BSI and/or other HAIs.
My understanding could be very flawed but I would appreciate insights and clarification around the process. I am happy to discuss the pros and cons of this approach and how APIC responded and the role it adopted offline, my contact details are below.
Regards and thanks
Cath
Dr Cathryn Murphy RN MPH PhD CIC
Executive Director
Infection Control Plus Pty Ltd
http://www.infectioncontrolplus.com.au
Cath@infectioncontrolplus.com.au
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This email and any attachments to it (the “Email”) is confidential and is for the use only of the intended recipient, and may not be duplicated or used by any other party without the express consent of the sender. If you are not the intended recipient of the Email, please notify the sender immediately by return email, delete the Email, and do not copy, print, retransmit, store or act in reliance on the Email. St Vincent’s Health Australia (“SVHA”) does not guarantee that the Email is free from errors, viruses or interference. Emails to and from SVHA or its related entities may be scanned and filtered in locations outside Australia.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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Any unauthorised use, alteration, disclosure, distribution or review of this email is strictly prohibited. The information contained in this email, including any attachment sent with it, may be subject to a statutory duty of confidentiality if it relates to health service matters.
If you are not the intended recipient(s), or if you have received this email in error, you are asked to immediately notify the sender by telephone collect on Australia +61 1800 198 175 or by return email. You should also delete this email, and any copies, from your computer system network and destroy any hard copies produced.
If not an intended recipient of this email, you must not copy, distribute or take any action(s) that relies on it; any form of disclosure, modification, distribution and/or publication of this email is also prohibited.
Although Queensland Health takes all reasonable steps to ensure this email does not contain malicious software, Queensland Health does not accept responsibility for the consequences if any person’s computer inadvertently suffers any disruption to services, loss of information, harm or is infected with a virus, other malicious computer programme or code that may occur as a consequence of receiving this email.
Unless stated otherwise, this email represents only the views of the sender and not the views of the Queensland Government.
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The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.
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- The forum ‘Infexion Connexion’ is closed to new topics and replies.