Infectious Disease Management Among Leading Health Systems

Introduction

Over the last three decades, there has been a concerning increase in the incidence of infections caused by multidrug-resistant organisms (MDROs). According to the Centers for Disease Control and Prevention (CDC), more than 2 million people in the United States are infected with antibiotic-resistant bacteria annually, and at least 23,000 of these individuals die due to their infection. Invasive methicillin-resistant Staphylococcus aureus, or MRSA, alone accounts for over 80,000 infections and 11,285 deaths per year. Sepsis, a life-threatening condition often caused by this type of bacteria, has become the leading cause of hospital readmissions and associated costs, accounting for 12.2% of 30-day readmissions and an average cost of over $10,000 per readmission.

In order to reduce the burden of MDROs in healthcare settings, the CDC recommends a multifaceted strategy that focuses on the prevention of infections, accurate and prompt diagnosis and treatment, and prudent utilization of antimicrobials. The advancement of rapid diagnostic testing (RDT) has allowed clinicians to more quickly identify and appropriately treat infections. To further enact this strategy, many organizations have implemented antimicrobial stewardship programs and treatment guidelines aimed at improving patient outcomes and preventing the proliferation of MDROs.

One report estimates the total economic cost of lives and productivity lost as a result of infections with MDROs will total $100 trillion globally by 2050. At the same time, the increase in value-based payment models and financial risk assumed by health systems creates an impetus to minimize readmissions and decrease healthcare-associated infections (HAIs), which negatively impact reimbursement. As costs associated with infectious diseases continue to rise and hospital operating margins continue to shrink, health systems are under increasing financial pressure to more effectively treat and manage their infectious disease patient population.

Methodology & Respondent Profile

The Health Management Academy (The Academy) has set out to identify key trends in health system approaches to infectious disease management, including the use of technology, rapid diagnostic testing, and treatment guidelines. From December 2018 through January 2019, The Academy conducted an online survey of senior clinical executives at Leading Health Systems (LHS) regarding their infectious disease management strategy. The responses collected represent the perspectives of 20 unique health systems.

Profile of Participating Health Systems

  • Median Net Patient Revenue (NPR):$3.4 billion
    • Large (>$6B): 25%
    • Medium ($3-6B): 40%
    • Small: (<$3B): 35%
  • Hospitals: 286
  • Beds: 65,000
  • Inpatient admissions: 3.2 million/year
  • Chief Medical Officer;
  • Chief Nursing Officer;
  • Chief Quality & Patient Safety Officer; VP, Quality & Patient Safety;
  • VP, Infection Prevention;
  • VP, Medical Affairs;
  • VP, Care Transformation;
  • Pharmacy Director;
  • Executive Director, Clinical Operations; System Director, Infection Prevention; Service Line Leader, Acute Medicine; Infectious Disease Specialist.

Key Takeaways

  1. Despite variation in the impact of infectious diseases on health systems and the processes they have created for managing these conditions, all health systems seek ways to better manage this patient population, given the agreement that there is insufficient reimbursement and an increasing cost of care for patients with infectious diseases.
  2. There is an opportunity to increase the utilization of technology among health systems seeking to better quantify the clinical and financial benefits of RDT, improve the delivery of rapid diagnostic test results, and support clinicians in leveraging these results in a clinical setting.
  3. While most health systems require prior authorization for antimicrobials and other agents, the methods health systems use to enforce these prior authorizations is highly variable. For this reason, there is a strong need for a tool to regulate and centralize prior authorization processes and facility-specific treatment guidelines.