- A proposed CMS rule to require antibiotic stewardship programs and improved patient safety techniques in hospitals is receiving widespread industry support. The Pew Charitable Trusts, as well as 6500 private citizens and 22 public health organizations, have voiced their approval of the new safety and quality guidelines, which would determine Medicare reimbursement eligibility for hospitals and critical access facilities.
“Antibiotic overuse is a major public health threat because it contributes to antibiotic resistance. Up to 50 percent of all antibiotics prescribed in the United States are estimated to be inappropriate by indication, agent, or duration of therapy,” explains the Pew Charitable Trusts in a letter addressed to CMS officials.
“We support proposed changes to the Centers for Medicare & Medicaid Services (CMS) conditions of participation that would require hospitals, including critical access hospitals (CAH), to develop and maintain an antibiotic stewardship program (ASP) in order to participate in Medicare and Medicaid reimbursement programs.”
The development of drug-resistant superbugs, coupled with increased financial penalties for hospital acquired infections (HAIs) and other patient safety events, has pushed the industry’s lack of antibiotic stewardship into the spotlight.
Recent research from the CDC has indicated that up to a third of antibiotic prescriptions are likely unnecessary. Providers often prescribe antibiotics for conditions that do not respond to the treatment, including colds, sore throats, and other viral infections.
Nearly 80 percent of hospitals routinely overprescribe antibiotics, the CDC said in 2014, and may be doling out combination therapies that present no real benefit to the patient, yet significantly increase the risks and costs of antibiotic use. Overuse of these medications could cost more than $12 million a year in avoidable expenses, the report added.
“Antibiotics are lifesaving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,” said Tom Frieden, MD, MPH, CDC Director in May of 2016. “Losing these antibiotics would undermine our ability to treat patients with deadly infections, cancer, provide organ transplants, and save victims of burns and trauma.”
In response to the rampant overuse of these medications, CMS is planning to make antibiotic stewardship a top priority. The proposed rule would require hospitals and CAHs to have organization-wide infection prevention and control protocols, as well as a comprehensive antibiotic stewardship plan to ensure appropriate use.
The Pew letter, authored by Kathy Talkington, Project Director of Pew’s Antibiotic Resistance Project and David Hyun, Senior Officer of the same program, notes that the proposal aligns with goals outlined by the White House National Action Plan for Combatting Antibiotic-Resistant Bacteria, and that antibiotic stewardship programs can reduce the risk of drug-resistant infections in patients while improving their chances of better outcomes if they do acquire an infection.
To further bolster the effort, the CMS proposal would require every hospital and CAH to designate an experienced ASP leader who has undergone appropriate training or certification. While Pew believes that a strong leadership structure is important for the success of any ASP, the organization points out that many healthcare providers lack the resources and qualified staff to meet the condition of participation.
“We agree that ASPs should ideally have a leader with expertise in infectious diseases or antibiotic stewardship as described by CMS,” Pew says. “We do, however, recommend that when surveying for compliance CMS take into account the inherent resource limitations that exist for small hospitals and CAHs, where personnel with infectious diseases or stewardship expertise may not be readily available.
Talkington and Hyun suggest that CMS provide additional guidance on the matter and offer training opportunities to potential ASP leaders, as well as more detailed resources aimed at helping hospital executives develop comprehensive ASP protocols and goals.
Nearly two dozen public health organizations and 6500 private citizens also expressed their “strong support” for the new recommendations, and urged CMS to fine-tune the antibiotic stewardship provisions of the proposed rule before it is finalized.
A dozen pharmacists and medical doctors, along with organizations including the American Medical Association, American Public Health Association, Kaiser Permanente Southern California, Sepsis Alliance, and Society of Critical Care Medicine put their signatures on the document.
“We strongly support the proposed conditions of participation requiring ASPs in hospitals,” the Pew letter concluded. “There is extensive evidence that ASPs are essential to improving antibiotic prescribing and optimizing patient outcomes, and that all inpatient facilities should implement these programs.”
“With these potential changes to existing regulations, CMS has reinforced the importance of ASPs and the critical role they play in reducing the threat of antibiotic resistance.”