HB 1742-FN – AS INTRODUCED

2006 SESSION

06-2124

01/09

HOUSE BILL 1742-FN

AN ACT relative to disclosing infections in hospitals and nursing homes.

SPONSORS: Rep. P. Johnson, Hills 26

COMMITTEE: Health, Human Services and Elderly Affairs

ANALYSIS

This bill requires hospital and nursing homes to make quarterly reports to the department of health and human services on infections acquired in such facilities. This bill requires the department to develop a methodology for collecting and analyzing the infection rate data.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

06-2124

01/09

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Six

AN ACT relative to disclosing infections in hospitals and nursing homes.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 New Subdivision; Hospital and Nursing Home-Acquired Infection Reporting. Amend RSA 151 by inserting after section 31 the following new subdivision:

Hospital and Nursing Home-Acquired Infection Reporting

151:32 Definitions, In this subdivision:

I. Commissioner” means the commissioner of the department of health and human services.

II. “Department” means the department of health and human services.

III. “Hospital and nursing home-acquired infection” means a localized or systemic condition that:

(a) Results from an adverse reaction to the presence of an infectious agent or agents, or its toxin or toxins; and

(b) Was not present or incubating at the time of admission to the hospital or nursing home.

151:33 Hospitals and Nursing Homes Required to Report.

I. Hospitals and nursing homes licensed pursuant to this chapter shall collect data on hospital and nursing home-acquired infection rates for the specific clinical procedures determined by the department by rule adopted pursuant to RSA 541-A, including the following categories:

(a) Surgical site infection.

(b) Ventilator-associated pneumonia.

(c) Central line-related bloodstream infections.

(d) Urinary tract infections.

(e) Other categories as determined by the department.

II. Hospitals and nursing homes shall submit quarterly reports on their hospital and nursing home-acquired infection rates to the department. Quarterly reports shall be submitted, to the department by April 30, July 31, October 31, and January 31 each year for the previous quarter. Data in the quarterly reports shall cover a period ending not earlier than one month prior to submission of the report. Quarterly reports shall be made available to the public at each hospital and nursing home and through the department. The first quarterly report shall commence January 31, 2007. If the hospital or nursing home is a division or subsidiary of another entity that owns or operates other hospitals, nursing homes, or related organizations, the quarterly report shall be for the specific division or subsidiary and not for the other entity.

151:34 Department to Develop Methodology.

I. In developing the methodology for collecting and analyzing the infection rate data, the department shall consider existing methodologies and systems for data collection, such as the Centers for Disease Control and Prevention’s National Nosocomial Infection Surveillance Program, or its successor; provided, that the department’s discretion to adopt a methodology shall not be limited or restricted to any existing methodology or system. The data collection and analysis methodology shall be disclosed to the public along with the disclosure of hospital and nursing home-acquired infection rates.

II. The department shall evaluate on a regular basis the quality and accuracy of hospital and nursing home information reported under this subdivision and the data collection, analysis, and dissemination methodologies.

151:35 Department Reports.

I. The department shall make an annual report, commencing on January 31, 2008, to the speaker of the house of representatives, the president of the senate, and the governor summarizing the hospital and nursing home quarterly reports and shall publish the annual report on its website. The department may issue quarterly informational bulletins at its discretion, summarizing all or part of the information submitted in the hospital quarterly reports.

II. The annual report shall compare the nursing home-acquired infection rates collected under this subdivision for each individual hospital and nursing home in the state. The department shall make this comparison as easy to comprehend as possible. The report shall also include an executive summary, written in plain language, that shall include, but not be limited to, a discussion of findings, conclusions, and trends concerning the overall state of hospital and nursing home-acquired infections in the state, including a comparison to prior years. The report may include policy recommendations, as appropriate.

III. The department shall publicize the report and its availability as widely as practical to interested parties, including, but not limited to, hospitals, providers, media organizations, health insurers, health maintenance organizations, purchasers of health insurance, organized labor, consumer or patient advocacy groups, and individual consumers. The annual report shall be made available to any person upon request.

IV. No hospital report or department disclosure shall contain information identifying a patient, employee, or licensed health care professional in connection with a specific infection incident.

151:36 Confidentiality. The patient’s right of confidentiality shall not be violated in any manner under this subdivision. Patient social security numbers and any other information that could be used to identify an individual patient shall not be released.

151:37 Rulemaking. The commissioner shall adopt rules, pursuant to RSA 541-A, relative to the manner of publicizing and posting the department’s annual report to the public as required under RSA 151:35.

151:38 Penalty. Any hospital or nursing home facility violating any provisions of this subdivision shall pay an administrative fine pursuant to RSA 151:16-a and be subjected to any other remedy provided under this chapter.

2 Effective Date. This act shall take effect January 1, 2007.

LBAO

06-2124

Revised 12/20/05

HB 1742 FISCAL NOTE

AN ACT relative to disclosing infections in hospitals and nursing homes.

FISCAL IMPACT:

The Department of Health and Human Services states this will have an indeterminable fiscal impact on state, county and local expenditures and state revenue in FY 2007 and each year thereafter. There will be no fiscal impact on county or local revenue.

METHODOLOGY:

The Department indicated three additional full-time positions would be needed to implement the required reporting systems: one Senior Management Analyst, labor grade 26 and two Program Planner III positions, labor grade 25. In addition, an information technology vendor would be hired to develop the required information technology specific capabilities at nursing home facilities. Additional funds will be needed for printing and postage, office supplies, telephone costs, office furniture, personal computers and training. The Department assumed the Senior Management Analyst would perform the following duties:

• Analyze data and establish criteria and standards for reporting hospital and nursing home acquired infections.

• Provide technical instruction to 26 hospitals and 89 nursing homes to assure data quality and consistency.

• Develop and perform risk adjustment techniques on reported data.

• Compile and produce the required statistical reports.

• Develop and implement the evaluation process involving hospital and nursing home providers.

The two Program Planner III positions will:

• Provide ongoing training and interpretation to the hospitals and nursing homes on the reporting system.

• Work with providers to develop and implement standardized surveillance methods.

• Define, develop and implement procedures and policies to achieve outcome measures of the reduction in hospital and nursing home acquired infections.

• Research and review hospital acquired infection data to ensure accurate and easily understandable summary reports.

The Department determined there is no uniform systematic method of data collection for tracking infections in nursing homes. A vendor would be required to establish standardized data collection and upgrade the existing dial-up method of data transmission to a web based reporting system.

The Department estimated, based on published data on hospital-acquired infections, that there would be 9.8 infections per 1,000 inpatient days. Based on New Hampshire’s 553,585 average annual inpatient days, there would be 5,425 hospital-acquired infections. The Department further assumed, based on information from the National Center for Health Statistics and Medicare, 15% (or 1,088) of nursing home residents in New Hampshire have infections.

The Department estimated the costs to administer this bill as follows:

	FY 2007(1/2 Year)	FY 2008	FY 2009	FY 2010
Salaries	$ 58,520	$122,324	$127,824	$133,537
Benefits	25,749	53,823	56,243	58,757
Current Expense	1,500	3,000	3,000	3,000
Equipment	10,500	0	0	0
Travel	563	1,125	1,125	1,125

Development of web-based reporting system           150,000

Contractor to consolidate acute hospital data on infection rates   30,000

Maintenance costs for hospital and nursing home service contracts	0	25,000	25,000	25,000
Total Expenses	$276,832	$205,272	$213,192	$221,419

The Department indicated there may be long-term savings from lower infection rates resulting from hospitals and nursing homes reporting and the Department publishing information on hospital and nursing home acquired infection rates. These savings could impact state, county and local expenditures for health care. Any savings to the state would also decrease state revenue for the federal share of reduced Medicaid costs. The Department is not able to quantify these potential savings.