On Wednesday the House Appropriations Subcommittee on Labor, HHS and Education held a hearing on a National Strategy to Reduce Healthcare Associated Infections. Witnesses included the Directors of the CDC, and AHRQ, Deputy Assistant Secretary for Health of HHS, a representative for the American Hosptal Association, representative for the New York State Department of Health, and Peter Pronovost of Johns Hopkins (and checklist fame). Their testimony can be found here.

All agreed that Hospital Infection rates were insupportable—HAIs being the third leading cause of death in the United States. Pronovost pointed to a lack of investment:

Healthcare Acquired Infections killed about 7 times more people than AIDS in 2007. Yet that year the Federal Government spent $23 billion on domestic and global HIV activities with 2.6 billion for HIV/ AIDS research. Though welcome and overdue, the stimulus package included 50 million for HAI. The entire budget for AHRQ was $300 million. The investments to improve quality of care in general and HAI in specific are glaringly inadequate for the magnitude of the problem.

He recommended a combination of government regulation and what he called a free-market approach—arguing that what’s needed is agreement on which outcomes to measure and then standardizing that measurement through regulation. Once the data is standardized (and thus, presumably, reliable) we can let individuals innovate solutions. Regulation, he said, is too slow for innovation.

An issue of contention (between the department of health and AHA reps) was mandatory v. voluntary reporting of infections. More specifically, that mandatory reporting represents an unfunded mandate—possibly straining hospitals’ infection control budgets, while voluntary reporting is likely biased.

Medicare non-reimbursement for certain HAIs was discussed under the topic of incentives or pay-for-performance measures as an effort to decrease infection rates. According to AHRQ, this non-payment isn't costing hospitals that much money, but it is increasing awareness in the C-suite as the change impacts accounting.

Finally, accountability was the word of the day. Representative McCollum stressed that measurement drives accountability. Lee and Roybal-Allard took it one step further, arguing that the fear of litigation--or holding one party accountable and making them pay--is a powerful incentive that might be utilized to reduce HAIs. Predictably, on this point there was a significant Republican-Democrat divide.

What to watch for: HAI reduction plans, which must be submitted by each state by 2010.