Facing payment cut: Mayo battles ‘C Diff’

FAIRMONT — About a month ago, the federal government lowered Medicare payments by 1 percent for one year at more than 750 hospitals, 17 of them in Minnesota, as a penalty for having a high rate of “patient injuries.”

This 4-year-old program was created as a financial incentive to encourage hospitals to avoid infections and other mishaps, taking into consideration rates of infection and 10 types of in-hospital injuries.

Mayo Clinic Health System in Fairmont has been on the list the past two years, but Amy Long, administrator at the facility, said being on the list “could be a little misleading” about the quality of care provided.

One of the factors that caused the Fairmont hospital to be on the list involved 12 cases of Clostridium Difficile, more commonly known as C Diff, during the yearlong data collection period.

According Roger Drahota, infection preventionist at Mayo in Fairmont, C Diff is an invisible spore in the intestinal tract that is spread by people who don’t wash their hands after using the restroom and then touch a public object such as a door knob or shopping cart handle, thereby infecting others. C Diff, which he called “rampant,” can live for a long time in a person’s intestinal tract until an incident such as a dose of antibiotics can impact the “good” intestinal flora necessary for digestion and cause the C Diff spores to start attacking the intestine.

Long said it all comes down to when a hospital patient is tested.

“The way that the infection rate is counted could be a little misleading. Absolutely,” she said. “A patient can be admitted, and they come in with C Diff, but if we test on the third or fourth day and it comes back positive, we own it. It becomes our issue.”

After the patient is treated for C Diff, any additional test within four to six weeks still will register as positive. The test for C Diff is part of the gastrointestinal panel physicians order for many of their patients.

“It’s not like we’re accumulating a lot of different lab tests because the panel can enable an appropriate diagnosis,” Long said. “If it comes back positive, that’s now going to be considered a ‘hospital acquired infection’ versus a community acquired infection. That’s a pretty strong term — ‘hospital acquired.'”

Another significant factor is the size of the hospital that appears on the list.

“Our census numbers certainly come into play as well. It’s typically the mid-size or smaller facilities on the list because of our lower (patient) volume,” Long said.

A handful of patients testing positive for C Diff in a small hospital would represent a higher percentage of total admissions than a larger facility.

Long said the Fairmont medical facility has intensified education for providers in terms of when it is appropriate to test for C Diff initially and not to re-test too early. If they test too early or too often in an effort to stay ahead of the problem, the hospital could get fined for that.

“Reviewing our protocols for appropriate time of testing — that’s something we continually do. Education to providers on our infection rates — that’s ongoing. It comes down to what was the true origin of C Diff,” Long said.

“It’s really hard to explain to people. We don’t want people thinking that if they’re admitted as a patient and are diagnosed with C Diff that it’s a result of being in our facility because that is not accurate.”