Perspective

CMS requires antimicrobial stewardship for US hopsitals

CMS has proposed new standards to improve infection prevention and reduce antibiotic overuse in U.S. hospitals.

According to the agency, the proposed rule applies to 6,228 hospitals and critical access hospitals that participate in Medicaid or Medicare. It requires hospitalwide infection prevention and control and antibiotic stewardship programs, among other measures.

CMS projects that the proposed requirements, which build 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 and Quality at CMS, said in a press 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 also would 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 the 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 Aug. 15; comments can be submitted electronically through the e-Regulation website at https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/eRulemaking/index.html?redirect=/eRulemaking. – by Chelsea Frajerman Pardes

CMS has proposed new standards to improve infection prevention and reduce antibiotic overuse in U.S. hospitals.

According to the agency, the proposed rule applies to 6,228 hospitals and critical access hospitals that participate in Medicaid or Medicare. It requires hospitalwide infection prevention and control and antibiotic stewardship programs, among other measures.

CMS projects that the proposed requirements, which build 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 and Quality at CMS, said in a press 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 also would 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 the 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 Aug. 15; comments can be submitted electronically through the e-Regulation website at https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/eRulemaking/index.html?redirect=/eRulemaking. – by Chelsea Frajerman Pardes

    Perspective
    John Lynch

    John Lynch

    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 for Clostridium difficile infection and multidrug-resistant infections, including many hospital-acquired infections. The CMS proposed rule 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 was 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 affecting 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.

    • John Lynch, MD, MPH
    • Medical director of infection prevention, Harborview Medical Center Member, Infectious Diseases Society of America

    Disclosures: Lynch reports receiving funding from the Washington State Hospital Association to support education and implementation of ASPs in Washington.