The Impact of Infection on Controlling Costs

The incidence of infections acquired during hospitalization, contributes to an additional annual estimated $45 billion in direct hospital costs. Medicare, Medicaid and some insurance companies no longer pay for some healthcare acquired infections (HAIs). CareSafe helps organizations focus on prevention with safe, cost effective solutions. Controlling the spread of infection will create a safe environment. Investing in infection prevention will pay off.

HAIs are the 4th leading cause of death and cost healthcare over $7 billion dollars annually.

Estimated Cost of HAIs

Infection Rate (x/100 Admissions)

Annual Total Infections

Annual Cost of Infection

Annual Total Cost of Stay

Below Average = 1

250

$3,818,750

$6,475,750

Average = 4.5

1,125

$17,184,375

$29,140,875

Above Average = 5.0

1,250

$19,093,750

$32,378,750

Admissions = 25,000 patients
Average Cost of Infection = $15,275
Average Cost of Stay = $25,903

 

36% More Revenue at Risk

Program

2013 % Payment at Risk

2013 Revenue at Risk

2015 % Payment at Risk

2015 Revenue at Risk

Infection reporting to NHSN

2%

$1,000,000

2%

$1,000,000

Value-based Purchasing

1%

$500,000

1.5%

$750,000

Readmissions

1%

$500,000

3%

$1,500,000

Bottom quartile of infections

N/A

N/A

1%

$20,000

Total payment at risk

$2,020,000

$3,770,000

Cost of extended stay due to HAI

$2,800,000

$2,800,000

Total direct costs and penalties

$4,820,000

$6,577,000

Source: Becker’s Hospital Review, A. Boris, March 15, 2013, A Revenue Leak Soon Turns to Flood
Assumptions: 250 Bed Hospital, 10,000 Admissions, 4% Infection rate, 7 days extended stay

 

Long Term Care Rehab Patient; Presents as C. diff symptomatic on Day 8 of Part A Stay

Day 1 – 7 Reimbursement Rate (Ultra High Rehab RUGS Category RUX)

$849/day

Facility Reimbursement Revenues (7 days at RUX rate)

$5,943

C. diff Isolation (Days 8 – 15)

Look-back determines new rate

Facility Eligible Reimbursement(Based on Look-Back Classification; Clinical Complex RUGS Category CE1)

$326/day

Facility Adjusted Reimbursement Revenues (7 days isolation)

$2,282

Lost Reimbursement Revenues (Based on Adjusted Eligible Rate)

($3,661)

Loss for year based on 1 episode per month

($43,932)