P4P programs aim to track, prevent growing MRSA epidemic

METHICILLIN-RESISTANT Staphylococcus aureus (MRSA), a type of bacterium that is resistant to certain antibiotics, has become a national epidemic, with increasing numbers of serious infections, hospitalizations and deaths. Hospital stays for these infections tripled from 2000 to 2005.

"There is no question that health management of MRSA should be an important consideration for health plan executives, especially when one looks at the fact that MRSA infections also can lead to death and serious complications," says Rajiv Jain, MD, chief of staff, Veterans Affairs Pittsburgh Healthcare System (VAPHS).

The Centers for Disease Control and Prevention (CDC) subcategorizes MRSA infections as healthcare-associated MRSA (HA MRSA) infections, which occur in hospitals and healthcare facilities among patients with weakened immune systems or after an invasive procedure; or as community-associated MRSA (CA MRSA) infections, which occur in otherwise healthy people who have not had a recent hospital stay.

"It is not simply hospital MRSA that has moved from hospital to community," Pearson says.

Laboratory data show that CA-MRSA strains are distinct. They are resistant to fewer antibiotics than the hospital variety and affect younger, healthier patients with no link to the healthcare setting, she says.

Mary Beth Minyard, associate project leader, bacteriology, at Southern Research Institute in Birmingham, Ala., says CA strains are now being readily transmitted within hospitals.

"Evidence shows that community-associated MRSA genes responsible for encoding [antibiotic] resistance are more readily transferred to other S. aureus strains than genes from the typical hospital-associated genotypes," Minyard explains. "This potentially will result in higher MRSA rates within our healthcare settings, which ultimately results in higher infection rates and increased hospital stays and costs."

IMPACT ESTIMATES VARY

Although experts agree estimating MRSA's impact is a challenge, the latest study from the CDC, published in the October 2007 Journal of the American Medical Association, estimates that there are about 94,360 MRSA-related invasive infections annually, resulting in an estimated 18,900 deaths-a calculated 20% mortality rate. HA infections make up about 85% of the invasive cases.

According to the Agency for Healthcare Research and Quality, in 2005, there were about 368,800 hospital stays with a MRSA infection discharge diagnosis in the United States.

Cost burden varies, but is in the tens of billions of dollars annually. Each MRSA infection results in prolongation of hospital stays and bears excess treatment charges. Incremental costs associated with treating a patient in the United States who has developed a MRSA bloodstream infection can range from $35,000 to $40,000, according to William R. Jarvis, MD, president, Jason and Jarvis Associates, a consultant in epidemiology, infection control and infectious diseases.

A national survey by the Association for Professionals in Infection Control and Epidemiology (APIC) in 2007 shows that among hospitalized patients, MRSA colonization or infection was reported in 8,654 patients-a rate of 46.3 per 1,000 inpatients, which is eight to 11 times higher than previous MRSA estimates, using different methodologies.

In May, APIC conducted a follow-up poll to determine if additional MRSA interventions had been adopted since June 2007. The results indicate that 54% of infection prevention and control professionals say their institutions are not doing as much as they could and should be doing to prevent the spread of MRSA. However, 76% polled have implemented additional prevention measures in the last year.

Health plans also are recognizing their roles in reducing MRSA transmission. Some are instituting pay-for-performance measures to influence provider adoption of evidence-based interventions.