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CMS proposes rule to improve infection prevention, reduce inappropriate antibiotic use
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CMS has announced a rule proposal aimed at "strengthening Conditions of Participation related to infection prevention and antibiotic prescribing in U.S. hospitals and critical-access hospitals."
According to a press release from the agency, the rule applies to 6,228 hospitals and critical access hospitals that participate in Medicaid or Medicare.
CMS projects that the proposed requirements, which builds on initiatives from the CDC, HHS, Partnership for Patients and the National Quality Strategy, could save hospitals $284 million each year, improve care and save lives.
"Working with tools provided by the Affordable Care Act, hospitals have taken significant steps to improve safety and quality in the past several years," Kate Goodrich, MD, MHS, director of the Center for Clinical Standards & Quality at CMS, said in a release. "Already, efforts to reduce health care-associated infections have resulted in reducing health care costs by nearly $20 billion and saving 87,000 lives. This proposal further supports hospitals' safety and quality efforts by requiring all Medicare and Medicaid hospitals to have designated leaders in charge of specialized programs to prevent infections, improve antibiotic use, and follow nationally recognized guidelines."
The proposal would also require critical access hospitals to implement Quality Assessment and Performance Improvement programs.
In addition, the rule would prohibit discrimination by advancing "protections for traditionally underserved and often excluded populations based on race, color, national origin, sex (including gender identity), age, disability, or sexual orientation."
"This rule marks the first time that CMS has proposed explicitly to prohibit hospitals that accept Medicare and Medicaid from discriminating against patients," Cara James, PhD, director of the CMS Office of Minority Health, said in a release. "We know that barriers still remain in accessing quality care for communities that have been traditionally excluded or underserved. This proposal reinforces the principle that access to needed health services should not be blocked because of discriminatory practices."
The rule is open for comments until August 15; comments can be submitted electronically through the e-Regulation website. – by Chelsea Frajerman Pardes
Perspective
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John Lynch , MD, MPH
The value of effective antimicrobial stewardship programs (ASPs) in improving patient safety and outcomes is clear. ASPs increase appropriate antimicrobial use, decrease adverse drug effects, and decrease the risk of Clostridium difficile infection and multi-drug resistant infections, including many HAIs. The CMS proposed rule released yesterday would finally require the establishment of antimicrobial stewardship programs in acute care and critical access hospitals across the U.S. This comes after the proposed rule for ASPs in long-term care facilities released in the fall of 2015. Although many hospitals have ASPs, many still do not, especially smaller community hospitals and critical access hospitals due to lack of human resources and, in some cases, expertise. In facilities with fewer resources that have established programs, the responsibility often has been given to a pharmacist without ASP experience, in addition to multiple other responsibilities and often without physician involvement, which is critical for effecting behavior change in prescribers. The emphasis on an effective ASP by the proposed rule will support adding more resources to this important area of patient safety and may support innovations that address these needs, such as tele-stewardship programs. While allowing some flexibility, the rule requires several specific goals including documentation of antimicrobial use according to guidelines and demonstration of improving antimicrobial use. The implication of these two requirements could be considered to be quite broad (surveillance and documentation) but can be modeled on the successes of ongoing infection prevention and control programs. This approach is supported by the Conditions of Participation by recommending integration of ASPs and infection prevention and control programs while also recognizing the different skill sets of the involved team members and leadership. The proposed rule is a step forward in using evidence-based action to further improve patient safety in an area of care that has a great deal of room for improvement.
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