CIED infections are difficult to manage.

Suggested CIED infection protocol¹

1. Complete extraction of hardware,
2. Complete debridement of the infected scar tissue,
3. No reimplantation at the primary extraction procedure,
4. Sustained antibiotic therapy (minimum of 2 weeks), and
5. Reimplantation at remote anatomic location.

Additional information regarding proposed management guidelines for cardiac device infections are available.^2,3

• CIED infection costs can exceed reimbursement.⁴

A.2009 nationalaverage reimbursement rates for DRG 243 and 227 derived from 2009 IPPS final rule:
http://www.cms.hhs.gov/AcuteinpatientPPS.

B.Based on 2006 national average cost to charge ratio of 0.487545; source: www.hcupnet.ahrq.gov.

 

…And reimbursement for hospital-acquired infections is at risk.

• Hospital Acquired Conditions (HACs) - high volume and high cost
• As of October 2008, eight preventable events including urinary-tract infections, vascular-catheter-associated infections and mediastinitis were categorized as “never pay” event 
• Medicare has begun to stop compensating hospitals for treating certain “reasonably preventable” Hospital  Acquired Conditions”
• CMS continues to require that hospitals report, and make publically available, 30 quality (outcome) measures
• CMS continues to require that hospitals report all diagnoses (e.g., infection) that were acquired during a hospital stay or Present on Admission (POA)

1. Wilkoff Bl et al. How to treat and identify infections. Heart Rhythm, 2007;4(11):1467-1470.
2. Sohail, M et al. JACC, 2007;49(18):1851-1859.
3. Baddour et al. Circulation. 2010;121(3):458-477).
4. 2009 national average reimbursement rates for DRG 243 and 227 derived from 2009 IPPS final rule: Wise, R. et al. Medical Supplies and Devices. Leerink Swan Healthcare Equity Research. May 4, 2009.