Long-term care providers should take pride in their antipsychotic reduction efforts, and certainly should work hard to meet the new goals announced Friday. But it should not escape their notice that just a day earlier, the White House released an ambitious national plan for addressing antibiotic resistant infections. The plan suggests that a facility’s antibiotic stewardship is about to join its antipsychotics rate as a defining feature of quality in the eyes of the government.
A centerpiece of the White House plan is a new interagency federal task force charged with implementing the “National Strategy for Combating Antibiotic-Resistant Bacteria.” This strategy consists of five goals, and long-term care features prominently in goal No. 1: “Slow the development of resistant bacteria and prevent the spread of resistant infections.”
To achieve this, the strategy calls for strengthening antibiotic stewardship programs in long-term care and other settings, beefing up monitoring and reporting, and expanding “collaborative efforts by groups of healthcare facilities.”
The White House has given the task force six months to detail “specific steps” that agencies will take to implement the national strategy. For some idea of what might be coming, providers should look at the recommendations issued by the President’s Council of Advisors on Science and Technology (PCAST), which also were unveiled Thursday.
Prominent among these recommendations is a phrase that might have providers girding themselves: “reimbursement incentives.” Specifically, long-term care facilities should have to adopt an antibiotic stewardship program as a Condition of Participation in Medicare and Medicaid by the end of 2017, PCAST proposed.
The group also pushed for increased measurement of antibiotic usage and resistance in healthcare facilities, and specifically stated that such data should “be the basis” for Hospital Compare quality measures. A system already is in place for hospitals to voluntarily report this information, making acute care a natural place to begin this push; it does not seem bold to predict that a similar quality measure would be developed for nursing homes.
A frequent (and often fair) complaint is that the government imposes new expectations and mandates even as it trims reimbursements and otherwise drains provider resources. In this case, it appears the federal government is going to pony up (at least to some extent) to help providers and other stakeholders succeed.
For example, the White House announced a $20 million prize for the development of a rapid, point-of-care diagnostic test that healthcare providers could use to diagnose highly resistant bacterial infections. The government also is calling for accelerated research into new antibiotics and antibiotic alternatives. And the plan is not scapegoating or unduly targeting healthcare; it truly broad is in scope, encompassing the agricultural sector and promoting international collaboration.
Providers surely won’t be surprised by this push from the executive branch, given that government agencies such as the Centers for Disease Control and Prevention have been increasingly sounding the alarm on antibiotic resistance. And the long-term care sector obviously understands the pressing need to get terrible infections like MRSA and C. diff under control. Still, the promise of new mandates and requirements understandably could elicit groans from this overregulated sector.
The good news is that many long-term care providers have sharpened their medication management skill set, as the antipsychotic reduction numbers demonstrate. Previously skeptical staff members have seen how: scaling back on inappropriate prescribing can improve residents’ quality of life; administrators and frontline caregivers have learned how to discuss medication alternatives with families; and systems are in place to make med pass more efficient and to gather the data to create more evidence-based protocols around drug administration. Considering all these tools and skills, long-term care providers might greet the White House plan not with anxiety and dread but as a chance to burnish a reputation that is gaining luster in the nation’s capital.
Tim Mullaney is McKnight’s Senior Staff Writer. Follow him @TimMullaneyLTC.