Infection Prevention Non-Compliance:
When Cutting Costs Leads to Cutting Corners
By Phenelle Segal, RN, CIC, Founder, Infection Control Consulting Services
Healthcare organizations are under tremendous financial pressure. They are facing decreasing reimbursement and increasing costs for supplies, equipment, medications and staffing. Owners of organization are feeling their own personal financial pressure due to uncertainty in the U.S. and global economy triggered by Brexit, the upcoming U.S. presidential election, huge swings in oil prices and many other issues.
As margins tighten, it is only natural for organizations and their owners to explore ways to reduce costs. Tasks and services not associated with contributing to the bottom line are often targeted first for cuts as a seemingly easy way to increase gross profit.
But when these tasks and services concern patient safety and compliance with regulations, small financial gains are often wiped out and easily surpassed by the expenses associated with problems that develop down the road.
This is a scenario our consultants at Infection Control Consulting Services (ICCS) frequently witness firsthand. When organizations find themselves under financial distress, infection prevention efforts are often scaled back. This can include reduction in staff education, such as education provided through webinars and attending local and national meetings; frequency of staff training on infection prevention processes, rules, regulations and accreditation standards; and time allocated for infection-related performance improvement projects and QAPI (quality assurance and performance improvement) planning.
In addition, our consultants witness suboptimal development of infection prevention programs, creation and use of infection prevention risk assessments, and accreditation preparation.
While scaling back or eliminating these various infection prevention-related efforts and services will save money, there are several important considerations often overlooked before cuts are made:
- CMS, state and accreditation surveyors will not accept "financial constraints" as a valid explanation for failed compliance. Standards must always be followed, regardless of an organization's profitability.
- When standards are not followed, the ramifications can be significant. They can range from minor citations to the extreme of being given an "immediate jeopardy," which could result in substantial fines, loss of CMS contracts/licenses and potentially the closing down of an organization.
- A poor survey performance could become public news, which will harm an organization's reputation, could lead to loss of patient volume and may be a deterrent for physician recruitment.
- A poor survey may require bringing in an outside consultant(s) for assistance with developing and executing a corrective plan of action as well as providing staff training. Since this will likely need to be a time-sensitive matter, organizations may find it challenging to continue normal operations while changes are integrated and staff receive required training.
- Staff morale is affected when their organization does not prioritize supporting efforts to ensure patient care and safety.
Then there's the biggest risk of all: patients could develop infections. In 2011, there were an estimated 722,000 healthcare-associated infections (HAIs) in U.S. acute care hospitals; about 75,000 patients with HAIs died during their hospitalizations. Patients develop HAIS in other facility types as well. Billions of dollars are spent each year treating HAIs. Many payors, including Medicare, no longer reimburse for treatment of HAIs. And treatment of individual infections can cost tens of thousands of dollars.
Consider the Repercussions
In this healthcare environment, it is critical to monitor expenses closely. All areas of an organization's operations should be evaluated regularly to ensure efficiency and eliminate waste. Not doing so would be a poor business practice that could jeopardize the viability of an organization.
But it is imperative that cost cutting does not come at the increased risk of compromised patient care. This practice is ethically wrong. In addition, the costs to address problems that may develop as a result of "cutting corners" will likely exceed the savings achieved from cost-reduction efforts.
Think twice before making cuts that could help grow the bottom line. If they come at the potential expense of ensuring high-quality, safe patient care, they may be expenses worth keeping.