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Comment & Response |

Will a Policy of Refusing Reimbursement for Health Care–Associated Infections Be a Sufficient Incentive to Drive Improvements?—Reply

Eyal Zimlichman, MD, MSc1,2; David W. Bates, MD, MSc1,3
[+] Author Affiliations
1Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
2Sheba Medical Center, Ramat-Gan, Israel
3Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
JAMA Intern Med. 2014;174(5):823-824. doi:10.1001/jamainternmed.2014.36.
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In Reply We appreciate the comments provided by Krupka et al regarding our article.1 The first point raised by Krupka et al related to true savings by hospitals. Although we agree that only part of total cost savings will be accrued by the hospitals, we believe that the fraction is vastly higher than the 10% to 15% they suggest. From our experience and according to some of the literature,2 direct costs make up approximately 40% of total costs in hospitals, with the remaining 60% accounting for indirect costs (which include allocated overhead and fixed capital costs that remain unaffected by avoided adverse events). Regardless of the actual fraction of total costs, we believe that the high costs we identified (eg, $45 814 for central-line–associated blood steam infection) should still motivate hospital administrators to invest in preventing health care–associated infections (HAIs). Indeed, the experience with the Meaningful Use health information technology program shows that hospitals responded vigorously to relatively modest financial incentives.3 As discussed in our article,1 expansion of the nonpayment rule for in-hospital complications and the inability to “upcode” current diagnosis related groups because of complications, most of which are HAIs, will further act to incentivize hospital administrators to act. Lastly, there will be shrinking margins for hospitals with the upcoming regulatory changes that will demand more attention from administrators to any cost savings opportunity.


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May 1, 2014
Dan Krupka, PhD; Warren Sandberg, MD, PhD; William Weeks, MD, MBA
1Twin Peaks Group LLC, Lexington, Massachusetts
2Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee3Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee4Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee
5Department of Psychiatry, Geisel School of Medicine, Dartmouth, New Hampshire6Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth, New Hampshire
JAMA Intern Med. 2014;174(5):823. doi:10.1001/jamainternmed.2014.39.
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