2022 | Worrilow, Kathryn Colonna
Accepted for presentation at the 2023 LeadingAge Fall Financial Conference
Abstract
Long term care teams are driven to provide the best care for their residents while simultaneously striving to minimize costs. One of the major sources of added costs to a long-term care facility (LTCF) are illnesses and infections. Each illness or infection in the LTCF requires doctor visits, potential isolation, increased monitoring, licensed nurse follow-up, additional medications, quarantines, lock downs, and has the potential for the resident to be admitted to the hospital. Most pathogens that cause illness and infection originate from the air. To minimize this variable, an advanced air purification technology (AAPT) was designed to comprehensively remediate volatile organic compounds (VOCs) while also destroying the DNA and RNA in all airborne pathogens, thereby rendering them noninfectious. A study was conducted comparing the clinical outcomes of the AAPT zone to a control zone with standard high efficiency particulate air (HEPA) filtration. It was hypothesized that the AAPT would be associated with improved clinical and economic metrics.
The AAPT was installed in a LTCF’s heating, ventilation and air conditioning (HVAC) ductwork and supplied ultra-pure contaminant free air to a memory support floor. A study was conducted comparing the floor receiving AAPT purified air plus HEPA filtration to another memory support floor with only HEPA remediation. Facility acquired infection (FAI) rates were studied along with staff call outs.
The FAI rates were calculated by dividing the total number of infections by the total number of patient days. A prospective evaluation of the data comparing the FAI rates between the control floor and the study floor revealed a statistically significant 39.6% reduction in FAIs. A retrospective evaluation comparing FAI rates on the study floor pre- and post-installation yielded a statistically significant 54.5% reduction in HAIs. In order to confirm that there were no facility wide factors impacting the FAI rates during the study period, the pre- and post-installation HAI rates were evaluated on the control floor and were determined to have no statistically significant difference. In conjunction with the statistically significant reductions in FAI rates, the study team also noted a statistically significant 47% reduction in staff call-outs pre- vs. post-installation.
The statistically significant reduction in both FAIs and staff call-outs associated with the AAPT have significant economic impacts. There is a direct link between FAI rates and the Centers for Medicare and Medicaid Services (CMS) reimbursements. CMS pays up to $500 per day per resident and holds back 2% of the total payout. Facilities can earn back all or a portion of the 2% withheld based on their healthcare performance which is ranked by CMS based on their hospital readmission rates. A facility’s year over year improvement is considered along with facilities that rank among the top half of facilities nationwide. A 39.6% reduction in FAIs will not only be reflected in a facility’s year over year improvement but will also help the facility improve their overall rank to maximize their reimbursement. In addition, if a resident becomes ill with a FAI, they may have to be taken to the hospital which will cause the LTCF to lose their daily CMS payment for that resident. This payment will be lost for the duration of the resident’s stay in the hospital and will not be fully reinstated until the resident has returned to the LTCF for a predetermined amount of time. In addition, it is possible that the resident does not return to the LTCF due to death or out of fear of getting another life-threatening infection. If this occurs the LTCF must recruit a new resident and will lose revenue until they can do so. Reductions in FAIs from the AAPT have a direct and positive economic impact on the LTCF.
A 47% reduction in staff call-outs also has a significant positive financial impact. When a staff member calls out, the facility is required to replace this individual either by extending the shift of another worker, calling in someone who was scheduled to be off, or bringing in an agency nurse to cover the shift. Extending the shift for another staff member or bringing in an individual who was off will result in overtime costs for the facility plus the individual who called off will also still be getting paid. Calling in an agency nurse has negative ramifications both economically and clinically. Agency nurses typically cost significantly more than staff nurses and they disrupt the continuity of care causing increased care failures. The use of agency nurses is associated with increased patient falls, meal and medication errors, and has a negative impact on resident mental wellbeing.
The findings support the hypothesis that environmental factors impact clinical and economic metrics. The statistically significant reductions in FAIs and staff call-outs have a direct positive impact on facility economics along with the health and wellness of the staff and residents.