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

SPONSOR Anderson

ORIGINAL DATE

LAST UPDATED

01/24/07

HB 165

SHORT TITLE Patient Privacy & Infection Rate Disclosure

SB

ANALYST Geisler

ESTIMATED ADDITIONAL OPERATING BUDGET IMPACT (dollars in thousands)

FY07

FY08

FY09 3 Year

Total Cost

Recurring

or Non-Rec

Fund

Affected

Total

$65.0

$65.0

$130.0 Recurring General

Fund

(Parenthesis ( ) Indicate Expenditure Decreases)

SOURCES OF INFORMATION

LFC Files

Responses Received From

Department of Health (DOH)

Health Policy Commission (HPC)

SUMMARY

Synopsis of Bill

House Bill 165 would amend the Public Health Act to require that a hospital collect and report

on hospital-acquired infection rates for specific clinical procedures determined by rule of the

Department of Health (DOH). DOH would appoint an advisory committee to establish standards

and methodologies for data collection and to evaluate the data. DOH would promulgate and en-

force rules. HB165 would provide for individual patient privacy, and would establish penalties

for violation of patient privacy.

FISCAL IMPLICATIONS

The program envisioned by House Bill 165 is not part of the Department of Health FY08

operating budget request. DOH notes that funds will be needed to support the infrastructure

required to develop the methodology to collect and analyze the data or to develop the rules rela-

tive to the intent of HB 165. They have provided an initial operating budget impact of $65 thou-

sand a year for 1 FTE.

House Bill 165 – Page

2

SIGNIFICANT ISSUES

Infections acquired at hospitals are a serious issue. HPC notes that the CDC estimates that about

two million patients at U.S. hospitals develop infections each year, possibly leading to 90,000

deaths annually. A study by the American Journal of Infection Control in 2002 found that hospi-

tal-acquired infections add about $5 billion a year to health care costs. It is a commonly held be-

lief that collecting and publicizing infection-rate data may help improve hospital performance in

reducing infections. According to HPC, a total of 16 states have passed some form of infection

reporting legislation.

However, DOH notes that the Centers for Disease Control and Prevention’s (CDC) Healthcare

Infection Control and Prevention Advisory Committee (HIPAC) concluded in 2005 that there is

not enough evidence to determine whether mandatory public reporting of hospital acquired infec-

tions will reduce infection rates or provide useful information to consumers. Implementation of

an infection reporting system is a complicated endeavor. Please see additional discussion under

other substantive issues.

ADMINISTRATIVE IMPLICATIONS

DOH notes that its Division of Health Improvement (DHI) has resources to monitor the provi-

sions of this act through its Health Facility Licensing and Certification Bureau, consistent with

its current Hospital oversight role mandated by the federal Center on Medicare and Medicaid

Services (CMS). However, significant resources would be required to facilitate the advisory

committee, monitor and evaluate reports, disseminate findings, develop quality assurance and

improvement mechanisms for the project.

OTHER SUBSTANTIVE ISSUES

•

Reporting on hospital quality data appears to improve hospital performance.

HPC cites a

number of studies that show public reporting improves health provider performance. A

Health Affairs (Hibbard, et.al. April 2003) study evaluated the impact on quality improve-

ment of reporting hospital performance publicly versus privately back to the hospital. Mak-

ing 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 (National

Committee for Quality Assurance-NCQA) finds that the quality of care delivered by health

plans that publicly report on their performance improved markedly in 2003 (Source: NCQA).

•

Requirements to establish an infection data reporting system

. DOH states the following are

needed if hospital infection data is to be publicly reported:

1)

Standardized infection surveillance measures that address both healthcare-associated in-

fections (outcomes) and healthcare practices that have been shown to reduce the risk of

infection (processes) [i.e., all hospitals must measure the same infections or infection

prevention practices];

2)

Standardized methods for collecting, risk-adjusting, analyzing, comparing, and reporting

data;

3)

Computer systems that support a standardized data collection and reporting process and

improve the efficiency, accuracy, and effectiveness of infection surveillance programs;

House Bill 165 – Page

3

4)

The involvement of individuals who have expertise in infection surveillance and preven-

tion programs when designing, implementing, and evaluating a system for publicly re-

porting infection data;

5)

A mechanism to ensure that data reported will be useful and not misleading for consum-

ers and will provide hospitals with the information they need to guide their infection pre-

vention programs;

6)

Education for the consumer on infection prevention strategies and the meaning of the

data released in public reports;

7)

Adequate support for infection surveillance, prevention, and control programs to prevent

infection control personnel and other healthcare resources from being diverted away from

infection prevention activities and towards data collection.

8)

Research to determine the impact that public reporting of infection data has on patients,

consumers, and hospitals; and

9)

Adequate funding and infrastructure to support a public reporting system for healthcare-

associated infections.

•

Collection and use of hospital infection data is a complicated endeavor

. HPC notes that

health care providers say there is no universal method for obtaining infection rate

statistics, in part because it is difficult to determine whether a patient developed an infection

while in the hospital. Providers add that some hospitals are more likely to have higher infec-

tion 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 litiga-

tion, reward facilities that are less persistent in finding infections and force others to hire ad-

ditional 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.

A large part of the difficulty in measuring hospital-acquired infections will be definitional.

Will the definition include outpatients treated within the hospitals. Will it include a home

health agency operated by a hospital. Will it include ambulance service operated by a hospi-

tal, but the patient transported may never be in that hospital. In addition, discovery of infec-

tions, and determining the true time when the infection was acquired, is a difficult task.

•

Current infection surveillance efforts

. DOH notes that New Mexico currently has a process

in place through the New Mexico Department of Health for surveillance of infectious dis-

eases of public health significance. New Mexico’s list of ‘Notifiable Conditions in New

Mexico’ ([7.4.3.13 NMAC 6/30/2006] is maintained and updated in the context of the Na-

tional Notifiable Disease Surveillance System and includes a formalized process for public

input. Both the national system and the Notifiable Conditions in New Mexico do not require

reporting of healthcare-acquired infections. There has been significant debate at the national

and state levels about the best mechanism to monitor healthcare-acquired infections. New

Mexico has participated in discussions through its collaboration with the Centers for Disease

Control and Prevention (CDC), Council of State and Territorial Epidemiologists (CSTE), As-

sociation for Professionals in Infection Control and Epidemiology, Inc. (APIC), and the New

Mexico Hospital Association. The Joint Commission on the Accreditation of Health Care

Organizations (JCAHO) is the body that both sets and monitors the standards for patient

safety in hospitals. The role of state departments of health with respect to hospitalized patient

safety issues such as healthcare-acquired infections has not been clearly established

House Bill 165 – Page

4

HPC notes that some hospitals have begun publicly and voluntarily reporting their outcomes

as a demonstration of accountability to the public they serve. The New Mexico Hospital and

Health Systems Association has developed a voluntary reporting process (see

http://www.nmchecheckpoint.org

) for surgical infection prevention. Twenty two hospitals

out of thirty five hospitals participate in the program. Information on hospitals in NM is

available at the Medicare website

http://www.hospitalcompare.hhs.gov/hospital/home2.asp

.

ALTERNATIVES

HPC suggests that another option is to allow a voluntary task force of providers to develop their

own public reporting, assuming their data could be audited from an independent third party that

reports to the providers, DOH, and the Legislative Health and Human Services Committee.

AMENDMENTS

HPC suggested amendments:

1)

Page 4, line 10 defines hospital as a “general or special hospital." The bill should

nclude “limited service hospitals" which was a classification added by the legislature in

2003. (See 7.7.2 NMAC).

2)

An unknown , 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.

3)

The definition of what constitutes infection, and in particular nosocomial or hospital-acquired

infection, will be controversial. Suggest the bill not be specific on this as is the case on page

4, lines 13-18 and have the advisory committee as composed on page 2 ,line 18 define in-

fections. The CDC defines infection as “a condition that was not present or incubating in a

person at the time of admission to the hospital.

GG/nt