Medicare’s policy of refusing extra payment for certain preventable hospital infections did not, on its own, produce a measurable drop in those infections. A national study published in the New England Journal of Medicine in 2012 found no significant change in rates of central line-associated bloodstream infections or catheter-associated urinary tract infections after the policy took effect in October 2008. For patients, the lesson is that payment rules do not replace a hospital’s day-to-day duty to follow infection-control practices, and when a hospital fails at that duty and a patient is seriously harmed, medical malpractice may be at issue.
Hospital-acquired infections, also called healthcare-associated infections (HAIs), remain one of the most serious threats to patient safety in the United States. Davis & Davis represents Houston patients and families in hospital infection cases and other claims of medical negligence. For a broader overview of patient rights after an infection, see our article on hospital-acquired infections and your rights. This post focuses on the payment policies and what they mean for patients.
What Are Preventable Hospital Infections?
Not every infection a patient develops in a hospital is the result of negligence, because surgery and medical care carry inherent risks. Many hospital-acquired infections, however, are linked to failures in basic standards of care. Common types include:
- Central line-associated bloodstream infections (CLABSIs): Infections entering the bloodstream through catheters inserted into large veins
- Catheter-associated urinary tract infections (CAUTIs): Infections caused by urinary catheters left in place unnecessarily or improperly maintained
- Surgical site infections (SSIs): Infections that develop at the site of a surgical incision
- Ventilator-associated pneumonia (VAP): Lung infections in patients on mechanical ventilation
Some infections progress to sepsis, a life-threatening response that requires rapid recognition and treatment. Our article on hospital-acquired C. diff and sepsis discusses one example.
How Medicare Payment Policy Targets Hospital Infections
Federal payment policy has tried to give hospitals a financial reason to prevent infections. Two programs are most relevant.
The 2008 Nonpayment Policy
Beginning in October 2008, the Centers for Medicare and Medicaid Services (CMS) stopped paying hospitals the higher rate that would otherwise apply when certain hospital-acquired conditions developed during a stay, including CLABSIs and CAUTIs. In other words, a hospital could no longer receive extra Medicare payment for treating these infections when they were acquired in the hospital.
The Hospital-Acquired Condition Reduction Program
Starting with fiscal year 2015, CMS added the Hospital-Acquired Condition Reduction Program. Hospitals are ranked on a set of patient safety and infection measures, including CLABSI and CAUTI rates reported to the Centers for Disease Control and Prevention, and those in the worst-performing quartile receive a 1 percent reduction in Medicare payments.
What the Research Found
The 2012 New England Journal of Medicine study, led by Grace Lee of Harvard Medical School, compared infection rates before and after the 2008 policy in 398 hospitals and health systems. The researchers found no significant change in the rates of central line-associated bloodstream infections or catheter-associated urinary tract infections that could be attributed to the policy. Infection rates were already declining before the policy began, and that trend continued for targeted and nontargeted infections alike.
The authors and commentators noted that the payment changes were relatively small and that hospital coding data can miss many infections. Whatever the reason, the findings suggest that consistent adherence to prevention protocols, not financial incentives alone, is what protects patients.
The Scale of the Problem
The Centers for Disease Control and Prevention estimates that about one in 31 hospital patients has at least one healthcare-associated infection on any given day. Beyond the cost to the health care system, preventable infections cause significant patient harm, including prolonged hospital stays, additional surgeries, permanent injury, and in severe cases, death.
When Does a Hospital Infection Become a Malpractice Case?
Hospitals and providers have a legal and ethical duty to follow established infection-control protocols. When a provider deviates from that standard, through improper sterilization, lapses in hand hygiene, unnecessary or poorly maintained catheters, or inadequate monitoring, and a patient develops a serious infection as a result, a medical malpractice or wrongful death claim may be warranted. A hospital’s payment penalties do not compensate the patient; a civil claim is the way a harmed patient seeks recovery.
In Texas, these are health care liability claims under Chapter 74 of the Civil Practice and Remedies Code. A claimant generally must show that the provider failed to meet the applicable standard of care and that the failure caused the infection and resulting harm. Written notice must be sent to each provider at least 60 days before suit, a report from a qualified physician must be served within 120 days after each defendant answers, and claims generally must be filed within two years from the date of treatment. Texas also caps non-economic damages, at $250,000 per institution and $500,000 for all institutions combined, plus a separate $250,000 cap for physicians and individual providers.
At Davis & Davis, we represent Houston patients and families who have suffered serious harm from preventable hospital infections and other forms of medical negligence. If you believe inadequate infection control put you or a family member in harm’s way, please complete our contact form to request a free consultation.
Frequently Asked Questions About Hospital Infection Malpractice in Houston
Can I sue a hospital for an infection I got during my stay?
Yes, in some cases. Not every hospital infection gives rise to a malpractice claim, because infections are a recognized risk of medical care. If the infection resulted from a failure to follow established infection-control standards, such as improper sterilization, lapses in hand hygiene, or unnecessary catheter use, you may have grounds for a medical malpractice claim in Texas.
What types of hospital infections are most commonly linked to medical negligence?
Central line-associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections, and ventilator-associated pneumonia are among the infections most often associated with preventable care failures. They are tracked by the CDC and are subject to established prevention protocols.
Did Medicare’s nonpayment policy reduce hospital infections?
A 2012 New England Journal of Medicine study of 398 hospitals and health systems found no significant change in central line bloodstream infection or catheter-associated urinary tract infection rates attributable to the October 2008 nonpayment policy. Rates were already declining before the policy began.
What damages can I recover if a hospital infection caused serious harm?
You may be able to seek compensation for medical expenses, lost wages, pain and suffering, and long-term care costs, subject to Texas caps on non-economic damages. If a family member died from a preventable infection, surviving family members may have a wrongful death claim. Texas generally allows two years to file, so consult an attorney promptly.
How do I prove a hospital was negligent in causing my infection?
You generally must establish what the standard of care required, show that the hospital or provider deviated from it, and show that the deviation caused your infection and resulting harm. This usually requires review by qualified physicians, your complete medical records, and analysis of the hospital’s infection-control practices.
