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Editor's Note
December 9/23, 2013

Pay for Preventing (Not Causing) Health Care–Associated Infections

JAMA Intern Med. 2013;173(22):2046. doi:10.1001/jamainternmed.2013.9754

The reason to prevent health care–associated infections is to save lives, not costs. Readers might wonder then why we thought it was important to publish a systematic review of the costs of health care–associated infections.

The answer is that the editors believe that the extraordinary costs of these infections—an estimated $10 billion a year in the United States—will motivate health care administrators to invest in the necessary systems to decrease these infections. The costs of these investments are not trivial. Information technology systems to monitor infection rates (successful quality improvement projects require knowledge of baseline rates of infection and infection following interventions); dedicated time to educate clinicians; supplementary assessments of patients for need of lines, catheters, or ventilator support; and preventive measures (eg, chlorhexidine baths, oral care with antiseptic solution) are costly. This study, however, will enable hospital administrators to better prioritize their spending by allowing them to compare the costs of interventions with the savings accrued by avoiding infections.

In the past, one of the challenges in motivating system change through demonstrating the costs of health care–associated infections was that insurers paid hospitals for the additional costs owing to the infection. Under this perverse payment scheme, a hospital that invested money to decrease infections would pay “twice”: once for the intervention and once through not getting the additional money for treating the patient for the additional complication. This began to change in 2009 when Medicare stopped paying for hospital-acquired infections.

Not paying for hospital-acquired infections or errors is an important part of the movement toward paying for quality, not quantity, of care. As physicians, we should embrace the opportunity that these new payment schemes offer for bringing higher-quality care—including fewer infections—to our patients.