Mandatory MRSA Reporting in Indiana?

Last Friday (January 16th) Indiana Representative Cynthia Noe (District 87) introduced legislation (House Bill 1539) which calls for mandatory public reporting of hospital MRSA rates. The current text of the bill is as follows:

SECTION 1. IC 16-21-2-17 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2009]:
Sec. 17. (a) As used in this section, "methicillin resistant staphylococcus aureus" means the strain of staphylococcus aureus bacteria, also known as MRSA, that is:
(1) resistant to oxacillin or methicillin; and
(2) identified according to the Clinical Laboratory Standards Institute's Performance Standards for Antimicrobial Susceptibility Testing.
(b) Each hospital shall develop a plan to reduce the incidence of persons contracting the methicillin resistant staphylococcus aureus infection at the hospital. The plan must include the specific strategies, patient screening practices, and infection control practices that the hospital will implement to reduce the incidence of methicillin resistant staphylococcus aureus infections.
(c) Before January 1, 2010, each hospital shall submit a plan prepared under this section to the state department. Each hospital shall submit an updated plan to the state department biennially.
(d) Before March 1 of each year, each hospital shall submit to the state department a report of the methicillin resistant staphylococcus aureus infection rate at the hospital during the previous year in a form determined by the state department.
(e) Information submitted to the state department under this section is a public record.

Although transparency in healthcare is a good thing, I don't think this legislation will accomplish much beyond creating a lot of busy work for hospitals. The resulting data will be of questionable value.

• The information submitted to the State Department of Health will be a public record.
• However, will the State Department of Health have the resources to crunch the numbers in a way that will allow for fair comparisons between hospitals? The financial impact statement for this bill has already been published. It says that this bill is not expected to have a financial impact on the ISDH. What that tells me is that there is no intention to create a system to risk-adjust the rates. In other words, it is the raw data that the public will have access to.
• How will the hospital know if the MRSA infection was pick up in the hospital or before the patient entered the hospital? Test EVERYONE upon admission to a hospital? Who will pay for that?
• What is the purpose of requiring all hospitals to submit an infection control plan to the ISDH? Will anyone read it? Will there be consequences for a hospital submitting a crappy plan? What if a hospital does submit a lame plan? Who's to say that it is lame? Who has the authority to send it back to the hospital for improvement? Ultimately, what's the point?

An alternative to the proposed legislation may be:

• Rather than reporting MRSA data to the state, why not require all Indiana hospitals to participate in the MDRO module of the CDC National Healthcare Safety Network (NHSN). Thus, all hospitals will be reporting data in a consistent method and contributing to a national surveillance database. One of the stated purposes of the NHSN is to "provide facilities with risk-adjusted data that can be used for inter-facility comparisons and local quality improvement activities." The problem with this is that facility level NHSN data is confidential and not available to the public. However, it is better to collect data that has a purpose (ie, for the CDC NHSN) than collect data that has questionable purpose (ie, for ISDH). Either way, facilities become aware of their own MRSA rates. By participating in the NHSN, the data becomes useful to the hospital.
• Rather than having hospitals submit MRSA control plans to ISDH every 2yrs , why not change 410 IAC 15-1.5-2 (the Infection Control section of the state regulations for hospitals)? Sec 2(b) currently says "There shall be an active, effective, and written hospital-wide infection control program. Included in this program shall be a system designed for the identification, surveillance, investigation, control, and prevention of infections and communicable diseases in patients and health care workers." Why not add a subsection here to say that the written plan must specifically include the surveillance, internal reporting, control, and prevention of MRSA? This way, all hospitals will have an opportunity to show the ISDH the effectiveness of their MRSA control plan during the annual licensing survey. Poor or non-existent MRSA control plans will result in citations.

These two alternate ideas will accomplish what Indiana Representative Noe intended with her legislation but in a manner that will produce less "busy work" and more useful information for the purpose of quality improvement.