The ROI of Avoiding Antibiotic Overuse

June 10, 2016

Presented by:

James M. Keegan, MD

ALABAMA HOSPITAL ASSOCIATION

The ROI of Avoiding Antibiotic

Overuse

Prepared for Alabama Hospital Association Page 14

Presented by James M. Keegan, MD

Native Kingsport, Tennessee

Emory University, Atlanta, Georgia

U.S. Air Force, Ellsworth AFB

South Dakota Commendation: Meritorious Service

Chief of Medical Staff

University of Vermont

Infectious Disease Fellowship

1986-1990 Clinical Practice of Infectious Disease

with Fred Kerns, MD, Charleston WV

1990-2005 Clinical Practice Infectious Disease

1990-Pres Medical Director of Infection Control,

Rapid City Regional Hospital and Regional Health

(Western SD)

2001-Pres Medical Director

Antibiotic Stewardship,

Rapid City Regional Hospital

2005-2013 Administrative Leadership

in Regional Health Vice President Quality Chief Medical Officer

Chief Executive Officer of Regional Health

Physicians 1 of 5 Senior Executive

Team Members


Success is walking from failure to failure with no loss of enthusiasm.


Winston Churchill


He who knows best knows how little he knows.


Thomas Jefferson


Leadership is about making others better as a result of your

presence and making sure that impact lasts in your absence.


Sheryl Sandberg


The Problem Antibiotic Resistance

The Global Health Crisis

Each year in the U.S. at least 2-million Americans will become infected with bacteria that are resistant to antibiotics, and at least 23,000 die each year as a direct result... CDC

By 2050, more people will die (worldwide) from antibiotic resistance than from cancer. BBC


The Problem Antibiotic Resistance

The Global Health Crisis

20-50% of all antibiotics prescribed in U.S.

acute care hospitals are either unnecessary or

inappropriate.

Similar to the findings in hospitals, studies have

shown that 4075% of antibiotics prescribed in

nursing homes may be unnecessary or

inappropriate.

We can either work to improve antibiotic use and prevent infections,

or watch as the clock turns back to a world where simple infections kill people.

Tom Frieden, CDC


Historical Prescribing Practices

90-95% of all sinus infections

are viral, yet


Empiric Prescribing and Risks

At community hospitals, ONE of THREE

patients with bloodstream infections given

inappropriate therapy. Duke University

: Treatment given without knowledge of cause or nature of

disorder and based on experience, rather than logic.

Simple Definition of EMPIRICAL

empirical adjective | em-pir-i-kuh-l


The Dilemma for Physicians

Patient Expectations Prescribed antibiotic validates

illness Antibiotic often considered a

cure all Patient satisfaction scores

Physicians prescribe how they

have been historically trained

Treating the patient vs. solving

world issues


Regulatory Environment

Infectious Diseases Society of America (IDSA)

& Society for Healthcare Epidemiology of

America (SHEA) recommend antibiotic

stewardship as a Condition of Participation

by December 2017 to Centers for Medicare &

Medicaid Services (CMS)

CMS Requirement Immanent?

IDSA and SHEA letter to CMS, March 4, 2014.


Message Going Mainstream Growing Public Awareness of the Problem

USA needs to take

immediate steps to fight

super bugs, experts say.


Broad Spectrum Antibiotics

Use by State

Use of Quinolones in 2012

Source: IMS Xponent


MRSA

Incidence by Region


There is a disconnect, why?

Changing clinical behavior is difficult

Limited Antibiotic Stewardship experience

Broadcasting the problem does not equate with solving

the problem

Pharmacy champions and

others may not be

comfortable with task of

changing physician

prescribing behavior


What We Are Seeing

RESULTS

OBSERVATIONS

30 Hospital Collaborative


CDC Core Elements

13 Centers for Disease Control and Prevention, CDC, Core Elements of Hospital Antibiotic Stewardship Programs.

13 Centers for Disease Control and Prevention, CDC, Core Elements of Hospital Antibiotic Stewardship Programs.

Leadership Commitment

Accountability

Need Drug Expertise

Active Oversight

Tracking

Reporting

Ongoing Education

Antibiotic Stewardship


Our Philosophy

PRIMUM NON NOCERE


The Role of Diagnostics

Picture of lab things vials, samples, lab tests

Rapid Diagnostics

Pay now or pay more later

Prescribing contingent

upon lab results


Clostridium difficile (C.difficile)

Thoughts about this HAI

CDC Hazard Level Rank: Urgent Threat Assessment Highest

level

DEADLY: Contracting C. diff drastically reduces your chance of

leaving the hospital alive. If two patients come into the hospital with

the same diagnosis, the one who gets C. difficile is four times more

likely to die.

EXPENSIVE: $10K per incidence (national average)

I know that today I had 3 rooms closed down for C.diff. Meaning the patients

had discharged and the rooms steri-misted. Still have to confirm they're clean

before reopening them to accept patients. Normally takes 72 hours, depending

on when environmental services get there to steri-mist it


Valley Hospital ASP Results

C. difficile and ABX Correlation


Hospital Engagement Sample Results

C. difficile and Antibiotics Correlation


Penicillin

Allergy

If you are hospitalized and declare a penicillin allergy,

your mortality risk doubles if you are prescribed an

alternative medication

Avoiding penicillin means using alternatives that are less

effective, more expensive or have greater side effects

Add length of stay increase

Dangers for those /Treatment risk for those who think

they are allergic


Antibiotic Stewardship Program

Direct and Attributable Financial Benefits

20-50% reduction in total antibiotic expense with emphasis on broad spectrum antibiotics. Clinical improvement to more precise prescribing practices.

Reduce expenses associated with antibiotic inventory and related costs of maintaining inventory

Decrease C. difficile cases - 10% mortality rate and $10K per incidence cost associated with this HAI (national average)



Indirect Financial Benefits

Savings and improved outcomes that influence Value-Based Reimbursements

Avoids Unnecessary Admissions

Decreases LOS (Length of Stay)

Decreases Readmissions

Reduces risk for HAI (Hospital-Acquired Infections)

Improves DRG Sufficiency



Related Benefits

Public Relations and Improved Perceptions

Better Patient Care

Mitigate Legal Risk

Prepare for impending CMS Conditions of Participation related to the adoption of ASPs


Antibiotic Stewardship equals

Triple Aim

1. Improves Patient

Care and Outcomes

2. Reduces costs

3. Improves Health of a

Community

and it is Simply the Right Thing to Do.



Selected Programs and Savings

Location/Type of

Facility

Number of

Beds

Cost

Savings/Reductions

AS Team Composition

Monroe, Louisiana

Community Hospital

120 $177,000/ 1 Year ID Specialist, Clinical

Pharmacist

Dallas, Texas LTAC

Hospital

60 $159,580/ 15 Months ID Specialist, Director of

Pharmacy

Dorchester,

Massachusetts

Community Teaching

Hospital

159 $200,000-250,000/ 1

Year

ID Specialist, ID-trained

Pharmacist

Baltimore, MD Large

tertiary care, teaching

medical center

800 $2,949,705/ 3 Years

ID Specialist, Clinical

Pharmacist

Winston-Salem, NC

Academic Medical

Center

880 $920,070 to $2,064,441

per year over 11 years

2 ID Specialists, 3 Clinical

Pharmacists


RCRH Results

Rapid City Regional Hospital 417 Licensed beds

Ernst & Young ~$1 million antibiotic per

year cost savings


PYA ASP Team

Our Services

24/7 Access and Support of Infectious Disease Physician and

Team

20+ Years of ASP Experience with Proven Results

Train and Empower Physician and Pharmacy Champions

Concurrent Monitoring of Prescribing Practices

Ongoing Review and Data Analysis to Ensure Continued

Success

Transparent Reporting and Outcomes

Safety Bundle Recommendations


Public Health Crisis

resistance to antibiotics has become

a major threat to public health World Health Organization


PYAs ASP TEAM

Multidisciplinary Expertise


The most important weapon in your arsenal will be your ability to

adapt.


Batman

PERSHING YOAKLEY & ASSOCIATES, P.C.

800.270.9629 | www.pyapc.com

James M. Keegan, MD

[email protected]

(605) 408-6513

mailto:[email protected]

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