Proposed Indiana Law Mandates Hospitals to Offer Pneumococcal and Influenza Immunization.

What's the point?

A bill introduced 1/16/08 in the Indiana House of Representatives (and referred to the Committee on Public Health) requires all hospitals to offer immunization for influenza and pneumococcus. The current text of the proposed bill is as follows:

SECTION 1. IC 16-21-7.7 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2009]:
Chapter 7.7. Immunizations for Elderly Patients Admitted to Hospital
Sec. 1. This chapter applies to a hospital patient who:
(1) has been admitted to a hospital; and
(2) is at least sixty-five (65) years of age.
Sec. 2. For the period beginning September 1 and ending April 1 of the following year, a hospital shall offer to immunize a patient described in section 1 of this chapter against the following:
(1) Influenza virus.
(2) Pneumococcal disease.
Sec. 3. A hospital licensed under this article shall adopt an immunization policy concerning influenza and pneumococcal disease that includes the following:
(1) Identification of patients who are at least sixty-five (65) years of age and other patients the hospital determines are at risk.
(2) A procedure for offering the immunizations described in section 2 of this chapter upon the admission or discharge of a patient described in subdivision (1) for the period beginning September 1 and ending April 1 of the following year.
(3) A procedure for providing a patient or the patient's guardian with information describing the risks and benefits of the immunizations.
(4) A standing order policy approved by the hospital's medical director or other appropriate physician that includes an assessment for contraindications.
(5) A system for documenting:
(A) the administration of an immunization;
(B) medical contraindications;
(C) patient refusals; and
(D) any postimmunization adverse events.
Sec. 4. The state health commissioner may waive any of the requirements of this chapter if there is a shortage of either of the immunizations specified in section 2 of this chapter.

What's the point of introducing legislation on a topic that is already "mandated" by CMS? Given the hospital industry's acceptance that future reimbursement is going to be tied to performance on publicly reported measures (which includes immunizations), hospitals have been trying to increase their performance on these measures for several years.

CMS's Value Based Purchasing program will decrease the reimbursement of poorly performing hospitals. Thus there is both reward and punishment built into CMS's mandate for immunization.

Despite this motivator, a quick scan of how a few random Indiana hospitals are performing with this measure is surprisingly disappointing. Many hospitals successfully offer to immunize eligible patients less than 80% of the time. Hopefully, these hospitals have started a PI project to address their underperformance in this measure.

Along comes this proposed law to require hospitals to offer immunization to patients older than 65yrs. With the law comes no incentive or consequence for noncompliance. Will hospitals now suddenly feel even more compelled to offer immunizations? Not likely. If money and public reporting is not going to motivate a hospital to offer immunizations to their patients, I doubt a law with no consequence will do anything.

If this law passes as it, it will be an incredible waste of time. All that will happen is that hospitals will write a policy, file it, and get on with their day to day tasks. It is not likely that this bill in its current form will change or improve anything.


Random Indiana Hospital Performance
January 2007 to December 2007
Pneumonia Patients Given Influenza Vaccine:
100.0% COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY,
98.51% National Top 10%,
97.09% REID HOSPITAL & HEALTH CARE SERVICES INC, IN
95.46% COLUMBUS REGIONAL HOSPITAL, IN
91.84% PARKVIEW HOSPITAL,
91.05% MAJOR HOSPITAL, IN
90.30% UNION HOSPITAL, INC, IN
86.17% BALL MEMORIAL HOSPITAL INC, IN
84.62% COMMUNITY HOSPITAL,
83.58% ST FRANCIS HOSPITAL -INDIANAPOLI, IN
83.33% MARION GENERAL HOSPITAL, IN
83.33% HENDRICKS REGIONAL HEALTH, IN
81.89% National Middle 50%,
81.82% RIVERVIEW HOSPITAL, IN
81.16% BLOOMINGTON HOSPITAL, IN
79.00% Indiana State Average,
74.29% HENRY COUNTY MEMORIAL HOSPITAL, IN
68.38% ST VINCENT HOSPITAL & HEALTH SERVICES, IN
58.07% CLARIAN WEST MEDICAL CENTER,
56.00% HANCOCK REGIONAL HOSPITAL,
55.86% National Bottom 25%,
50.00% WHITE COUNTY MEMORIAL HOSPITAL, IN
47.06% CLARIAN HEALTH PARTNERS, INC D/B/A METHODIST,IU,
37.50% WESTVIEW HOSPITAL, IN
*Data from www.whynotthebest.org on 1-24-09