Current CDC data finds that about one in 31 hospital patients has at least one healthcare-associated infection (HAI). While hospitals can implement measures such as improved disinfecting protocols, equipment standards, and streamlined processes, another side to be considered is the cost incurred by such conditions. The treatment associated with HAIs can make patient medical expenses rise, but this usually also results in greater cost utilization on an organizational level.

For this reason, the topic of hospital-acquired infections is one that insurers and health care facilities alike are trying to decode. Twenty states and counting have mandated their hospitals to report any instances of HAI to the National Healthcare Safety Network. Such a mandate is a crucial step, but policies also need to be reformed as they pertain to payment for services that treat HAI.

Existing research posits that the primary determining factor for preventing HAIs is the reimbursement strategy. This is often dependent on whether hospitals operate using diagnosis-related groups (DRGs) or on a per diem basis. Additionally, federal lawmakers have implemented pay-for-performance measures to improve hospital adherence to prevention standards and, therefore, lower the frequency of HAIs. These measures also prohibit Medicare
from offering more reimbursement for patients who have HAIs.

Another way that health insurance companies can decrease reimbursement for HAIs is through shared savings programs, which reward insurers and care organizations who simultaneously lower health care costs while also meeting quality standards. There has been consideration given to the adoption of financial penalties to further spur on a lower rate of hospital-acquired infections.

It seems that one of the best ways to improve a health care insurer’s performance in regards to infection control is to speak their language. This is why financial incentives and even fines have been deemed as the only effective plan as of now. Insurers stand to gain a lot from encouraging health care organizations to adopt better prevention programs. This will not only directly reduce the number of claims they receive, but this also helps draw in additional groups to utilize their services and benefit from a lower HAI rate.

Insurers looking to lower infection rates in the hospitals within their network should encourage the implementation of these programs. If your company needs assistance in this process or is struggling to acclimate to the needs of their network, TOG Network Solutions can offer industry-leading services to aid in the transition.