The report by Makary and colleagues is published in the current issue of the Journal for Healthcare Quality. It points to other studies showing that surgical site infections not only result in 8,000 deaths a year in the U.S., they occur in 4% to 25% of patients who undergo major surgical procedures, and their cost to the healthcare system is about $10 billion annually.
Asked why states have not been more forceful in requiring consistent, uniform reporting of surgical site infection rates, Makary blames state hospital associations, which "are actively lobbying against public reporting.
"Many states have come up with public reporting mechanisms, and they've been shot down a lot of times," he says. "I don't think there's an incentive for a hospital business manager, a CEO with a business background who is running the business, to say 'I'm going to put out stats that could hurt my business if we perform poorly in a year.' "An administrator for a hospital with a surgical infection rate that is five times higher in one hospital than its competitor would worry that it "could potentially kill the hospital," he says.
There are some indications that change is coming, however. As of Jan. 1, 2012, the Centers for Medicare & Medicaid Services instituted pay-for-reporting measures for any infection related to colon surgery or abdominal hysterectomy. This will affect payment with discharges in fiscal year 2014. Any surgeries and infections that ensue must now be reported quarterly to the Centers for Disease Control and Prevention's National Healthcare Safety Network, and shared with CMS, which will include them on HospitalCompare.
That's good, but not good enough, says Makary, because those two procedures don't capture the hospitals' real rates of surgical site infections. "Those are just two operations, out of hundreds that are commonly done," he says. At Johns Hopkins, of the 250 operations done each day, only about one is a colon surgery and only about two are abdominal hysterectomies.