Delays Hinder Effort to Protect Medicare, Medicaid Patients From Superbugs

CMS should finalize stalled policy to improve antibiotic use in U.S. hospitals

Delays Hinder Effort to Protect Medicare, Medicaid Patients From Superbugs
Hospitals would be required to develop and maintain antibiotic stewardship programs under a new rule
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In 2016, the Centers for Medicare & Medicaid Services (CMS) proposed a new policy to improve patient safety and help address the growing threat of antibiotic resistance. Two years later, progress remains stalled despite broad stakeholder support.

The updated policy, which will require hospitals to develop and implement antibiotic stewardship programs (ASPs), is part of a broader set of updated standards—known as “conditions of participation” (COP)—that these facilities must meet to take part in Medicare and Medicaid programs.

Changes for hospitals that CMS proposed in June 2016 have not been finalized. Meanwhile, CMS completed similar policy updates for long-term care facilities  in September 2016 that are already being implemented.

And while there have been encouraging advances from nongovernmental hospital accrediting organizations, such as The Joint Commission, to require and improve antibiotic stewardship programs, they do not affect as many hospitals as the CMS policy would. When finalized, CMS’s hospital COP update would affect more than 6,000 hospitals nationwide. By contrast, The Joint Commission accredits only about 4,000 hospitals.

Antibiotic stewardship protects patients, public health

These stewardship programs are designed to ensure that patients receive the right antibiotic at the right dose for the right duration—and only when needed. Ensuring appropriate use slows the emergence of antibiotic resistance because the more antibiotics are used, the less effective they become.

Unfortunately, extensive overuse of these drugs continues in U.S. health care. Up to half of all antibiotics prescribed in U.S. acute care hospitals are unnecessary or inappropriate.

In addition to reducing rates of antibiotic resistance, ASPs can lower the risk that patients will develop life-threatening infections, such as Clostridium difficile—which can result in life-threatening diarrhea— or suffer from allergic reactions and other adverse effects caused by antibiotics.

Effective stewardship is possible in all types of health care settings

The tools available to help hospitals to implement ASPs include guidance from the Centers for Disease Control and Prevention. And because no one-size-fits-all approach to stewardship exists, CDC, along with The Pew Charitable Trusts, the American Hospital Association, and the Federal Office of Rural Health Policy, developed specific guidance to help smaller rural hospitals implement ASPs.

CDC and Pew also have published strategies for facilities to assess their antibiotic use in order to drive improvements. The Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America have developed ASP guidelines as well. Evidence from a variety of facilities with diverse staffing and financial resources demonstrates both the feasibility of implementing ASPs and the possible improvements in economic and patient outcomes from such efforts.

What needs to be done

CMS should ensure that hospitals have updated standards, just as it did for long-term care facilities, and finalize the hospital stewardship rule as soon as possible. Ensuring appropriate use of antibiotics will slow the spread of antibiotic resistance and protect vulnerable patients from harmful side effects.

David Hyun, M.D., works on The Pew Charitable Trusts’ antibiotic resistance project.

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