Since surviving a tough battle with MRSE in the fall of 2005, about a third of my waking thoughts are consumed with the question of how do you win the war with the invisible enemy called bacteria. I have a bookcase full of textbooks, studies, recommendations, and evidence-based science. The experts all agree that there are no easy answers, no miracle cures, no silver bullets. I helped pass the infection reporting law in Colorado but have come to believe that we cannot write laws that are detailed enough, flexible enough, or tough enough to win this war.
In the past two decades we have witnessed the corporate takeover of healthcare. Interestingly, corporations are very much like bacteria. Both exist for the sole purpose of growth and survival. The means for corporate survival has always been and will always be profitability. While some will deny this fact, and others will spend their lives trying to get corporations to act morally, the truth is that profits will always take precedence over quality of care. Consider the two things that you will never hear come out of a healthcare CEO’s mouth:
- We made too much money this year!
- We lost money this year but that is acceptable because we didn’t harm any patients!
The plan to win the war is simple. Make infection prevention highly profitable. Currently this nation spends about $4 billion dollars a year treating two million infections which at 7% profit equates to about $280 million dollars a year in healthcare profits. Most experts would agree that if we spent that same $4 billion a year on prevention measures, infections would be nearly extinct. The problem is that neither insurance companies nor CMS would pay for $4 billion in prevention measures; thus the resulting $8 billion dollar swing from revenue to overhead would bankrupt a lot of providers.
My solution is to quit paying providers an average of $2,000 per patient to treat the unlucky souls that get infected, and instead give them a $25 bonus for every patient they don’t infect. They then get $5 billion in revenue but now it is distributed to the providers with the best rates instead of going to the facilities with the worst rates. Infections will become extremely hazardous to the bottom line. Corporate healthcare, like bacteria, will quickly adapt, morph, and change into mean, clean, bacteria-killing machines. The providers that I have proposed this to have an interesting response: “But would we have to share the bonus with the doctors?” Again the profit-centered culture. The right answer is “Yes, of course,” as doctors (especially surgeons) are integral to stopping infections.
No one will argue that hospitals are grossly understaffed in infection control, that screening takes money, and that isolation wings cost big money. Give them the funds to fight the war effectively and quit rewarding them for failures!
Kerry O’Connell 4/14/08