The Centers for Medicare and Medicaid Services (CMS) uses a Prospective Payment System (PPS) to provide incentives for healthcare providers to be effective and efficient. Much like health maintenance organizations (HMOs), the PPS provides a flat fee for each service, encouraging providers to stay within efficient financial limits. (In contrast, the older fee-for-service model incentivized over-utilization of services.) Each year, CMS releases changes to the PPS, in their efforts to remain flexible to changing medical needs and feedback from patients and providers. Earlier this month, CMS released the final inpatient rule (all 2,087 pages), including a few important changes.
Measuring the cost-effectiveness of an infection prevention intervention requires careful translation of complex issues into dollar values: The problems, the possible solutions, the methods of evaluation, and the desired outcomes. The result is a calculation that measures whether or not the costs associated with an intervention are outweighed by the benefits gained by that intervention. Today we will delve into the big ideas behind that final calculation.
When considering an infection prevention intervention, how should the costs be calculated? The first question should be what costs should be calculated? With the myriad of direct, indirect, and intangible costs related to HAIs, where is a facility to start? There are several types of costs to be taken into consideration, and each type will come from different sources. In this post, we will explore how a facility may collect cost data when evaluating a potential new infection intervention.
Any time a healthcare facility considers investing in a new intervention - a medicine, a device, a piece of equipment, and even a training program - one of the first considerations will be cost effectiveness. The facility has a responsibility, both financial and ethical, to weigh the cost of an investment with the likelihood and extent of patient benefits. We would all love to live in a world where hospitals could invest in any and all interventions without thought as to cost and return on investment. Instead, we face a reality in which not only are financial resources limited, but also personnel, space, and even time are constrained. As a result, when millions of dollars and patients' lives are at stake, calculating cost effectiveness of an intervention has a lot on the line.