Growing MRSA threat has Medicare limiting infection payments

Medicare will stop paying for treatment of some infections that arise in hospitals and are caused by germs such as MRSA, or methicillin-resistant Staphylococcus aureus, that are invulnerable to standard medicines. Treating resistant infections can cost as much as $300,000.

MRSA, once found primarily in hospital patients, now is surfacing among people in the community. Hard-to-treat infections in U.S. hospitals cost an estimated $20 billion annually nationwide. Beginning this month, about 160 Veterans Affairs Medical Centers will screen patients for the bacteria. The risk of losing Medicare payments is spurring other facilities to also test for the lethal germs.

"We're talking about many, many thousands of dollars," said Daniel Sexton, an infectious-disease doctor at Duke University. "It's a lot of money, and many hospitals already feeling squeezed will have a hard time affording it."

Bacteria frequently mutate into forms that are able to resist otherwise effective antibiotics. MRSA is especially hardy and doesn't respond to cheap, standard drugs such as penicillin, oxacillin and amoxicillin. Treating the bacterium can require medications costing as much as $1,500 a week.

MRSA now accounts for almost two-thirds of skin infections in emergency rooms, up from just 2 percent 35 years ago. About one in 20 patients hospitalized with the drug-resistant bacterium dies, according to government data published in July. Sales of antibiotics that work against MRSA infections will double over the next five years, to $2.5 billion, or 20 percent of the total market for antibiotics, according to New Brunswick, N.J.- based drugmaker Johnson & Johnson.

The cost of caring for a post-surgical chest infection can range from a few thousand dollars to more than a quarter-million dollars, according to an editorial published last month in the New England Journal of Medicine. Many hospitals are stepping up hygiene and hand-washing campaigns among doctors, nurses and other employees to combat the most common ways germs are spread.

Next October, Medicare will stop paying for chest infections after heart surgery and urinary tract infections that occur during a hospital stay. The U.S. health-care plan may also add bloodstream infections, which often occur in patients getting intravenous fluids, to the non-reimbursed list. Each bloodstream invasion can cost $4,000.

Local angle

Tucson's largest hospital, Tucson Medical Center, does not test all patients for MRSA upon entering the hospital, but does test those patients admitted or transferred to intensive-care units.

That same policy is going into effect at University Medical Center on Dec. 1. "We will test patients going into intensive care because that is the highest-risk group, with more life-threatening conditions," said Dr. Eskild Petersen, UMC infectious-disease specialist.

UMC will also select one floor of medical-surgical patients and screen them for MRSA upon entry — "to see if it makes a difference before we decide to do that for all patients," Petersen said.

However, universal, up-front MRSA testing of all admitted patients is being done at the Southern Arizona Veterans Affairs Medical Center, where patients also undergo repeated MRSA tests when they are transferred to a different unit, and when they are discharged.

— Arizona Daily Star