When hospitals too often fail to disclose and to adequately deal with their problems, patients and their loved ones suffer. That’s what happened during the coronavirus pandemic, when individuals admitted for other reasons were infected in hospitals and died of Covid-19 at alarming rates.
The federal government, separately, also is stepping up its efforts to get hospitals to comply with U.S. regulations to foster greater transparency in institutions’ pricing of medical goods and services.
The independent, nonpartisan Kaiser Health News (KHN) service, to its credit, has dug into publicly available data to show how Covid-19 became the latest problem pathogen spread in hospitals — part of the menace long known as HAIs or hospital acquired infections.
To be sure, this coronavirus was novel and caught the world by surprise. Medical staff struggled for months, and continue to do so, to provide intensive, courageous care for coronavirus patients.
Still, hospitals in this country have not disclosed well how this infection spread in caregiving settings, a move that, among other things, might provide greater insight in preventing future pandemic harms, KHN found, reporting:
“More than 10,000 patients were diagnosed with Covid in a U.S. hospital last year after they were admitted for something else, according to federal and state records analyzed exclusively for KHN. The number is certainly an undercount, since it includes mostly patients 65 and older, plus California and Florida patients of all ages. Yet in the scheme of things that can go wrong in a hospital, it is catastrophic: About 21% of the patients who contracted covid in the hospital from April to September last year died, the data shows. In contrast, nearly 8% of other Medicare patients died in the hospital at the time.”
Tracking this unacceptable toll should be a priority for institutions hard-hit by hospital-acquired coronavirus infections, KHN reporter Christina Jewett found:
“A KHN review of work-safety records, medical literature and interviews with staff at high-spread hospitals points to why the virus took hold: Hospital leaders were slow to appreciate its airborne nature, which made coughing patients hazardous to roommates and staff members, who often wore less-protective surgical masks instead of N95s. Hospitals failed to test every admitted patient, enabled by CDC guidance that leaves such testing to the ‘discretion of the facility.’ Management often failed to inform workers when they’d been exposed to covid and so were at risk of spreading it themselves. Spread among patients and staffers seemed to go hand in hand.”
A familiar and significant problem for hospitals
Federal regulators long have chased hospitals to improve infection-control procedures — from basics like handwashing by doctors and nurses to battling antibiotic-resistant bugs.
Infections acquired in health care settings, especially in hospitals, were a nightmare to as many as 2 million U.S. patients annually in pre-pandemic times, with 90,000 of them dying each year from HAIs. They added anywhere from $1,000 to $50,000 to patients’ health expenses, while imposing a direct hit of anywhere from $28 billion to $45 billion for institutions’ bottom lines, the Leapfrog Group found in 2018. Leapfrog is made up of employers and other large purchasers of medical services and says it seeks to improve the quality and safety of American health care.
The federal government, in a published study, found that hospitals — slammed by the pandemic — saw big increases in HAIs, the first such spikes in 15 years, according to a report from a University of Minnesota infectious disease center. Hospitals recorded rises “in rates of central-line–associated bloodstream infections, catheter-associated urinary tract infections, and ventilator-associated events saw significant increases in 2020 compared with 2019, particularly in the second half of the year,” UM’s CIDRAP reported. “There was also a significant rise in methicillin-resistant Staphylococcus aureus (MRSA) bacteremia.”
With medical personnel in hospitals coast to coast overwhelmed, exhausted, and demoralized by dealing with the deadly, fourth, summer Delta variant surge, this may not be the exact time for regulatory crackdown on hospitals for better infection control. Or maybe it is a powerful time to do so.
Jewett does report that loved ones of patients infected with the coronavirus in hospitals have little patience with health workers who balk at vaccination requirements, either by institutions or by the federal government (as soon will occur under an order by the Biden Administration). Jewett also raises questions about how hospitals might be required to report coronavirus cases as they must with certain types of HAIs.
In my practice, I see not only the harms that patients suffer while seeking medical services but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
As the coronavirus vaccines win increased acceptance and more Americans get the shots and boosters, patients are returning to hospitals for postponed and required non-coronavirus care. They are adding to heavy workloads of medical staff. Hospital administrators are struggling to keep their key personnel, as well as to ensure that non-Covid care returns to pre-pandemic quality norms. The MBA-holding guys in suits who run hospitals may have to cut institutions’ profits to pay front-line caregivers more — including to bolster infection-control efforts to battle an array of ills, including the coronavirus, spreading among staff and patients.
The importance of hospitals transparency on costs
Will patients also see increased hospital costs soon? Wouldn’t bet against it. That also is a reason to support the Biden Administration’s plans to stiffen penalties for hospitals that fail to comply on Jan. 1 with Trump Administration rules on price transparency.
The previous administration, to its credit, “to provide in an online, searchable way the rates for 300 common services, such as X-rays, outpatient visits, Cesarean deliveries and lab tests. In addition, hospitals must disclose the amount they are willing to accept in cash,” CNN reported. The federal government also told hospitals to detail the differing deals institutions struck with health insurers.
While a small percentage of institutions have disclosed the required information — providing regular folks and researchers with a bonanza of data on often huge disparities in hospitals’ costs — thousands have not. Hospitals faced minimal penalties for noncompliance, and Biden officials want to change this, increasing the charges to as much as $2 million per hospital.
We have much work to do to increase the safety, affordability, and quality of our hospitals, which must be much more candid with us all about their caregiving problems that may make us sicker or even kill us.
