Becker's Hospital Review

40 CMO / CARE DELIVERY CDC Issues New Prevention Guidelines for Surgical Site Infections: 5 Things to Know By Brian Zimmerman T he CDC published its long-awaited update on recommen- dations for the prevention of surgical site infections on May 3 in JAMA Surgery. e new guidance supplants the agency's previous SSI prevention guidelines issued in 1999. Here are five things to know about the new guidelines. 1. e CDC's Sandra Berríos-Torres, MD, served as the lead au- thor of the guidelines. 2. Researchers conducted a review of more than 5,000 studies published from 1998 through 2014. Among these studies, 896 underwent full-text review. Of the 896 studies, 170 studies were named eligible and were fully analyzed. 3. e research team separated recommendations into categories based on the quality of the evidence supporting the advisory. e categories include 1A, strong recommendation supported by high to moderate–quality evidence; 1B, strong recommendation supported by low-quality evidence; 1C, strong recommendation required by state of federal regulation; category II, a weak recommendation supported by marginal evidence which would likely result in the clinical benefits and harms; and no recommendation signaling an unresolved issue. 4. New recommendations include, but are not limited to: • Advising patients to complete a full-body shower the night before surgery • Administering antimicrobial prophylaxis prior to inci- sion during cesarean delivery • Applying an alcohol-based agent to the skin prior to sur- gery in most cases • Forgoing the use of plastic adhesive drapes as they are unnecessary for SSI prevention • Refraining from the application topical antimicrobial agents to the incision • Not withholding blood transfusions as an SSI prevention method 5. In an invited commentary discussing the guidelines also pub- lished in JAMA Surgery, Pamela Lipsett, MD, a professor of surgery at Johns Hopkins Medicine in Baltimore, wrote the new guidelines are useful to every surgeon because it distinguishes between what surgeons should to do to prevent SSIs and what remains unknown about SSI prevention. "How do guidelines help us in practice? When their development is rigorous, experts are used to systematically review the evidence and tell us what we can do (or not do) for most patients," wrote Dr. Lipset. "e guidelines by [Dr.] Berríos-Torres et al do exactly that, and they show us the way forward." n Dr. Peter Pronovost: This Unnecessary Regulation Doesn't Benefit Patients and Costs $500M Each Year By Heather Punke T he federal government re- quires preoperative testing before cataract surgery, which costs the healthcare system $500 million annually — but has no positive effect on patient health, according to a blog post in The Wall Street Journal. Peter Pronovost, MD, senior vice president with Baltimore-based Johns Hopkins Medicine and di- rector of the Armstrong Institute for Patient Safety and Quality, wrote the piece published in April. He cited a 17-year-old study in The New England Journal of Med- icine that found preoperative medical testing before cataract surgery "does not measurably in- crease the safety of the surgery." Dr. Pronovost and his colleague Oliver Schein, MD, an ophthalmol- ogist, also wrote a study titled, "A Preoperative Medical History and Physical Should Not Be a Require- ment for All Cataract Patients," published in the Journal of Gener- al Internal Medicine in March. Despite robust data supporting this conclusion, the tests "contin- ue to be required by the federal government and accrediting or- ganizations before every cataract surgery and other low-risk elective procedures," Dr. Pronovost wrote. Instead of performing the cost- ly tests on every cataract patient, those who need it can be identi- fied with a checklist, he noted. Dr. Pronovost wrote the require- ment may not be the only regu- lation that could be revamped or scrapped entirely without jeopar- dizing patient safety. For instance, CMS recently eliminated a regula- tion preventing nutritionists from writing diet orders. "Wise regulations have accom- plished much good in healthcare," he concluded. "Still, CMS should establish a process to identify, evaluate and revise or remove regulations that corset clinicians, increase costs and place burdens on patients without clear benefits to safety or quality." n 2 in 3 Medicare Clinicians Exempt From MIPS By Emily Rappleye T he majority of clinicians who bill Medicare will not have to com- ply with the Medicare Access and CHIP Reauthorization Act's Merit-based Incentive Payment System this year, CMS said. The agency mailed roughly 280,000 letters to physician prac- tices in May indicating the MIPS participation status for each clinician associated with the practices' Taxpayer Identification Number. CMS said 806,979 clinicians do not have to participate in the MIPS track of the program, while 418,849 clinicians will be required to participate. Exempt physicians may not meet the minimum threshold for the program — treating 100 Medicare Part B beneficiaries and billing at least $30,000 in Medicare Part B allowed charges per year. Others exempt from MIPS may qualify to participate in MACRA's alterna- tive payment model track, which offers potentially greater financial rewards for taking on more risk. n

• Cover