Becker's Clinical Quality & Infection Control

34 ANTIBIOTIC RESISTANCE & STEWARDSHIP CMS tackles antibiotic resistance with IPPS final rule: 4 things to know By Mackenzie Bean C MS' Inpatient Prospective Payment System final rule contains several changes to help combat antibiotic re- sistance among Medicare patients, which CMS Administrator Seema Verma outlined in an Aug. 2 blog post published in Health Affairs. Four things to know: 1. Medicare's payment system bundles the costs of all healthcare services performed for a single diagnosis into a diagnosis-related group, which incentivizes hospitals to use "older, cheaper antibiotics that may not be effective against drug-resistant infections," Ms. Verma wrote. 2. She also said most new cases of drug-resis- tant infections and deaths involve Medicare patients, since they oen have compromised immune systems and greater catheter use. is leads to longer lengths of stay and billions of dollars in unnecessary healthcare costs. 3. To address this issue, CMS updated the 2020 IPPS final rule to feature an alternative New Technology Add-On Payments pathway to help encourage more antibiotic devel- opment. e alternative pathway drops the "substantial clinical improvement" criteria many drugmakers have struggled to meet and increased payment from 50 percent to 75 percent for antibiotics designated as Qualified Infectious Disease Products by the CDC. 4. CMS also updated the severity level desig- nation for multiple ICD-10 codes involving antibiotic resistance. Hospitals can now clas- sify these cases using a "CC" designation, which indicates the presence of a complica- tion or comorbidity that requires hospitals to use more resources than those used for a typical patient with the same diagnosis. "Classifying drug resistance as a CC will increase payments to hospitals treating patients with [antimicrobial resistance], thus creating the financial flexibility for physi- cians to prescribe the appropriate new anti- biotics without imposing a new fiscal burden upon hospitals," Ms. Verma wrote. n AHRQ recruiting 250- 500 clinics for antibiotic stewardship program By Anne-Marie Kommers T he Agency for Healthcare Research and Quality seeks 250-500 pediatric/ adult ambulatory clinics to participate in its free 12-month program to decrease patients' exposure to unnecessary antibiot- ics, according to AAFP News. The program will begin in December 2019 and combines evidence-based guidelines with strategies to address the challenges of improving antibiotic prescribing. It is based on the AHRQ Safety Program for Improving Antibiotic Use. Participants will have access to resources including monthly webinars that outline the best practices of antibiotic stewardship, free continuing education credits for physicians who attend the webinars, and assistance with developing and sustaining antibiotic stewardship programs. The program will also help clinics to meet CMS Merit-based Incentive Payment System requirements, among other benefits. n Why these Columbus hospitals are training South African pharmacists on antibiotic resistance By Anne-Marie Kommers I n August, South African pharmacists underwent training on antibiot- ic resistance in neonatal intensive care units thanks to a program at The Ohio State University Wexner Medical Center and Nationwide Children's Hospital in Columbus, according to The Columbus Dispatch. South African pharmacists Azraa Paruk and Sonya Kolman visited Columbus from Aug. 4-15 to receive one-on-one mentoring and learn more about pharmacists' role in fighting infectious diseases. They will now relay what they learned to colleagues upon returning to South Africa, where clinician pharmacy is relatively new. The training comes in response to an antibiotic-resistant infection that killed 23 newborns at Chris Hani Baragwanath Hospital in 2018. At the time, a clinical pharmacist from Wexner Medical Center happened to be leading a training program at the South African hospital on antibi- otic resistance in adults. The hospital asked the pharmacist, Debbie Goff, PharmD, if she could organize a similar program for NICUs. Dr. Goff partnered with colleagues at Nationwide Children's Hospi- tal to create the OSU-South Africa "Train-the-Trainer" NICU Antibi- otic Stewardship Pharmacist Mentoring Program. The program is expected to be as successful as the adult program, Dr. Goff said, which decreased the use of antibiotics by 18 percent in 47 South African hospitals. n

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