The current United States government is still relying on the widely held misconception that the health-care industry is in a competitive market and will improve its quality because of market pressures.
At the same time, access to health-care quality information — essential to consumers’ choice — is under attack.
The most recent example was an attempt by the Trump administration to repeal crucial infectious disease measurements. The repeal has been delayed, but if approved some of the measurements would have disappeared and others would have become dependent upon the endangered Affordable Care Act.
There also appears to be an aversion to the setting of guidelines and standards aimed at standardizing the practice of medicine and improving safety.
Sign Up and Save
Get six months of free digital access to the Lexington Herald-Leader
The most visible example is the shutting down of the Agency for Healthcare Research and Quality’s National Guideline Clearinghouse, an online database designed to provide health-care providers with ready access to easily understandable treatment guidelines.
The database contained approximately 1,400 guidelines which were developed over the last 20 years. Guidelines are critical to health-care providers for providing high-level standardized care, but if they became a standard then the physician could also be held accountable for not following them.
The lack of standards is inhibiting our ability to confront an epidemic of infectious disease. We are no longer the world leader.
For example, the World Health Organization, has recommended that before all major surgeries patients be tested for Staph. aureus, and if a country has the financial resources, that all patients undergoing surgery should be tested. However, the United States does not even have set standards for such testing or routinely test for carriers of the resistant form of Staph. aureus, MRSA.
The excuse I most often hear is that it is not cost efficient and who will pay for it? This seems ludicrous in light of recent reports of runaway hospital profits, with for-profit health-care systems seeing their net income jump by 20 percent compared to the same quarter a year ago.
The Centers for Disease Control recently reaffirmed a recommendation to isolate all individuals infected with or who are carriers of MRSA. But clouding the issue of what to do about drug-resistant bacteria was a commentary published in the CDC’s journal “Emerging Infectious Disease” that downplays the importance of isolating patients who harbor a bacteria without having an infection.
The commentary says carriers of dangerous pathogens have “limited relevance for the health of the carrier; carriage has little relevance outside health-care settings; and antimicrobial resistance is a slowly evolving threat on which individual carriers have limited effect.”
If the commentary is true, we all need to issue a posthumous apology to Mary Mallon, also known as Typhoid Mary.
In fact, the authors ignore myriad research and clinical experience that reaffirm the danger of being a carrier, both to the carrier and to others. Over the last decade we have heard and read numerous articles on the dangers of MRSA, so I hope many will not buy this argument. Obviously, carriers do pose a risk.
This type of risk adjustment is primarily designed to reduce the accountability of the health-care industry. It does not inform the public of the extent of the raging epidemic, or the chance they might acquire an infection while hospitalized. Patients need to be aware of this risk and to know the actual numbers of infections.
Kentucky’s two biggest hospital systems had some of the country’s highest instances of the often deadly bacterial bloodstream infection known as MRSA in fiscal year 2017. The University of Kentucky Chandler Hospital and Norton Healthcare in Louisville each had 40 MRSA bloodstream infections between July 1, 2016 and June 30, 2017, according to federal data from the U.S. Centers for Medicare and Medicaid Services.
One must also wonder, if there is a high rate of MRSA coming in from the community, why aren’t facilities doing universal screening and decolonization of all admitted patients? This is the protocol which is currently utilized by Veteran Affairs hospitals and has produced an 80 percent to 87 percent reduction.
And, if the epidemic of drug-resistant bacteria is advancing only slowly, why is the federal government urgently funding development and expediting approval of new antibiotics? My impression is almost everyone is preparing for an impending crisis.
Implying that carriers are not a risk in one setting creates a lackadaisical attitude to monitoring and safeguarding infections in other areas. This places both patients and staff at risk. We appear to be carving out exceptions for certain pathogens and groups of people, depending upon the whims of political influence and lobbying.
Kevin T. Kavanagh is a retired physician and board chairman of Health Watch USA.