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F I S C A L I M P A C T R E P O R T

SPONSOR Sanchez, M.

DATE TYPED 2-26-05

HB

SHORT TITLE Study Hospital-Acquired Infection Rates

SB SJM 45

ANALYST Collard

APPROPRIATION

Appropriation Contained Estimated Additional Impact Recurring

or Non-Rec

Fund

Affected

FY05

FY06

FY05

FY06

Minimal Non-Recurring General Fund

(Parenthesis ( ) Indicate Expenditure Decreases)

Relates to HB 823 and SB 775

SOURCES OF INFORMATION

LFC Files

Responses Received From

Department of Health (DOH)

Health Policy Commission (HPC)

Human Services Department (HSD)

SUMMARY

Synopsis of Bill

Senate Joint Memorial 45 requests DOH conduct a comprehensive study of hospital-acquired

infection rates in New Mexico and provide a written report by December 31, 2005 to the appro-

priate interim committee of the legislature.

Significant Issues

DOH indicates, as early as 1843, Oliver Wendell Holmes concluded that some form of fever was

spread by the hands of health personnel. Normal human skin is colonized with bacteria. Hospi-

tal settings are ripe with infections, sick people, and health care workers/medical staff who can

inadvertently transmit disease. In the context of a recent study, the authors report that surgical

site infections prolong hospital stays, are among the leading nosocomial causes of morbidity, and

a source of excess medical costs.

Hospital-acquired infections (known in the literature as healthcare-associated infections or noso-

Senate Joint Memorial 45 -- Page 2

comial infections) are infections associated with care received in an acute care facility defined by

the Centers for Disease Control and Prevention (CDC) as an infection that was not present or in-

cubating at the time of admission to the hospital. Hospitals in the United States, including New

Mexico, have had infection surveillance, prevention and control programs for over 30 years. In-

fection control practitioners throughout New Mexico has received specialized training in infec-

tion prevention, surveillance and epidemiology and they are the professionals who typically

oversee the infection control programs in hospitals. Currently DOH does not require reporting of

healthcare-associated infections, which are also not nationally notifiable conditions. Hospitals

are accredited through The Joint Commission on Accreditation of Healthcare Organizations

(JCAHO), an independent, not-for-profit organization. JCAHO is both the nation’s predominant

accrediting body as well as standards-setting organization for hospitals.

DOH indicates the study and public disclosure of hospital-acquired infections rates will facilitate

the provision of information that the public needs to choose hospitals that achieve low infection

rates and avoid those hospitals that do not achieve low infection rates.

FISCAL IMPLICATIONS

There is no appropriation and DOH indicates the department would address the memorial to the

extent resources, both fiscal and administrative, are available.

RELATIONSHIP

Senate Joint Memorial 45 relates to House Bill 823 and Senate Bill 775 which deal with infec-

tion rates disclosure and patient privacy. HSD indicates without those measures in place it may

be difficult for the secretary to fulfill this memorial as some hospitals may not collect these data

currently and without standardization of collecting and reporting methodologies it will not be as

useful a tool for consumers to make informed decision about where to have their hospital care.

TECHNICAL ISSUES

HPC notes page 4, line 2 defines hospital as a “general or special hospital.” The bill should in-

clude “limited service hospitals” which was a classification added by the legislature in 2003.

Additionally, an undefined, but large number of surgeries are performed every year in licensed

ambulatory surgery centers in New Mexico. Should these centers also be included in the bill.

Finally, HPC indicates the definition of what constitutes infection, and in particular nosocomial

or hospital-acquired infection, could be controversial and suggests the bill not be specific on this

as is the case on page 1, lines 22-25 and have the advisory committee as composed on page 2

define infections. CDC defines infection “as a condition that was not present or incubating in a

person at the time of admission to the hospital.”

OTHER SUBSTANTIVE ISSUES

HPC research shows CDC estimates that about two million patients at United States hospitals

develop infections each year, possibly leading to 90,000 deaths annually. A study by the Ameri-

can Journal of Infection Control in 2002 found that hospital-acquired infections add about $5

billion a year to health care costs. Advocates of collecting infection-rate data say the information

can help reduce the incidence of infections.

Senate Joint Memorial 45 -- Page 3

However, providers say there is no universal method for obtaining infection-rate statistics, in part

because it can be difficult to determine whether a patient developed an infection while in the

hospital. Providers add that some hospitals are more likely to have higher infection rates because

of patient mix, and a universal standard would need to account for these discrepancies. Hospitals

will say laws requiring data reporting could affect malpractice litigation, reward facilities that are

less persistent in finding infections and force others to hire on more record keeping staff.

Some infection control specialists say CDC data show that only about one third of hospital-

acquired infections are preventable and, even with infection-disclosure mandates, health experts

do not know just how far it is possible to reduce them.

Regarding hospital reporting, HPC indicates since the early 1990's there has been a proliferation

of healthcare quality report cards focusing on outcomes and processes of healthcare. Consumer

demand for public reporting of healthcare quality data has increased since a 1999 publication

from the Institute of Medicine reported 98,000 deaths in United States hospitals per year and $29

billion spent per year associated with medical error.

The literature shows that when outcomes are made public, results improve. A study reported in

Health Affairs (Hibbard, et.al. April 2003) evaluated the impact on quality improvement of re-

porting hospital performance publicly versus privately reporting back to the hospital. Making

performance information public appears to stimulate quality improvement activities in areas

where performance is reported to be low. The findings from this Wisconsin-based study indicate

that there is added value to making this information public.

A new study, by the National Committee for Quality Assurance finds that the quality of care de-

livered by health plans that publicly report on their performance improved markedly in 2003.

Using data from 1991 to 1999 a New York study showed that the reporting program has both

influenced patients' decisions of which hospital to attend and improved quality of care. Those

hospitals with low mortality rates see a positive flow of patients in the first year following a re-

port, but this increase declines soon after. In contrast, those hospitals identified publicly as offer-

ing relatively low quality surgery experienced a decline of 10 percent in the number of patients

during the first 12 month after an initial report and remained at that level for three years. How-

ever, their risk-adjusted mortality rate declined significantly -- about 1.2 percentage points.

Some hospitals have begun publicly and voluntarily reporting their outcomes as a demonstration

of accountability to the public they serve. One of Salt Lake City’s largest hospitals, Latter Day

Saints, which already had an infection rate below the national average, reduced its rate by half

between 1985 and 1995, largely by increasing how thoroughly doctors and nurses complied with

pre-surgical best practices. At Mercy Health Center in Oklahoma City, the surgical infection

rates for cardiac bypass, orthopedic surgery, colon and hysterectomy surgeries were reduced by

78 percent in one year. Another large Kentucky system, Norton Healthcare, has announced that

the health care system has voluntarily committed to measure and publicly report this spring on

a list of approximately 200 industry-consensus indicators for clinical quality and patient safety.

KBC/yr:lg