As part of the Omnibus Burden Reduction (Conditions of Participation) Final Rule (CMS-3346-F) issued today by the Centers for Medicare and Medicaid Services (CMS), the agency isfinalizing several of the proposed changes to modernize the hospital and CAH requirements, improve quality of care, and support HHS and CMS priorities. CMS believes that benefits of these finalized requirements will include: reduced incidence of hospital-acquired conditions (HACs), including reduced incidence of healthcare-associated infections (HAIs); reduced inappropriate antibiotic use; a proactive approach to quality assessment and performance improvement in CAHs; potential cost savings for some hospitals, CAHs, and insurers; and strengthened patient protections overall. CMS estimates an annual cost of approximately $98 million.

The benefits of these finalized requirements will include:

-- Updating hospital requirements for infection prevention and control programs, which do not fully conform to current standards of practice for the surveillance, prevention, and control of HAIs and other infectious diseases, and also requiring that hospital programs demonstrate adherence to nationally recognized infection prevention and control guidelines for reducing the transmission of infections within their hospitals;

-- Requiring hospitals to establish and maintain antibiotic stewardship programs to help reduce inappropriate antibiotic use and antimicrobial resistance. By requiring that hospitals have antibiotic stewardship programs that are not only active and hospital-wide, but also demonstrate adherence to nationally recognized guidelines for the optimization of antibiotic use through stewardship, the changes are aimed at effectively reducing the development and transmission of HAIs and antibiotic-resistant organisms that ultimately will greatly improve the care and safety of patients while adding cost benefits for hospitals;

-- Adding flexibility to the hospital CoPs by specifying that a unified and integrated infection prevention and control program may also include a unified and integrated antibiotic stewardship program for a multi-hospital system;

-- Requiring CAHs to have infection prevention and control and antibiotic stewardship programs similar to those being finalized for hospitals

The final rule (CMS-3346-F) can be viewed at: https://www.federalregister.gov/documents/2019/09/30/2019-20736/medicare-and-medicaid-programs-regulatory-provisions-to-promote-program-efficiency-transparency-and

This link will change once the final rule is published in the Federal Register on Sept. 30, 2019.

The Infectious Diseases Society of America (IDSA) issued a response to the release of the CMS final rule requiring antibiotic stewardship in hospitals as a condition of participation, noting, "The Centers for Medicare and Medicaid Services' new rule requiring hospitals participating in its programs to establish antibiotic stewardship programs will enable critical advances toward control of a major public health threat. The rule, which makes expert and coordinated interventions to improve the use of antimicrobial drugs mandatory in virtually all U.S. hospitals, will help curb inappropriate use of some of our most valuable medicines, reducing risks to patients and averting increased healthcare costs."

IDSA added, "The rule represents meaningful action against a growing crisis and is responsive to concerns raised by the Infectious Diseases Society of America, which, working with other organizations, has highlighted urgent needs for broad implementation of antimicrobial stewardship programs across all health care settings. IDSA has led advances in antibiotic stewardship with the development of the Antimicrobial Stewardship Centers of Excellence Program, which recognizes institutions that have created stewardship programs led by infectious diseases physicians and ID-trained pharmacists that are of the highest quality, as well as with resources to help practices and institutions implement stewardship programs such as the new Core Antimicrobial Stewardship Curriculum available through IDSA Academy. IDSA stands ready to guide practices and support institutions with the resources they need to perform effective stewardship."

The organization concluded, "While an essential step to controlling antimicrobial resistance, the rule will not on its own contain the threat. Stewardship can help limit the development of resistance, but even the necessary and appropriate use of antibiotics leads to resistance. With the evolving nature of infectious diseases, the need for a robust and renewable antibiotic pipeline capable of meeting current and future patient needs will continue. IDSA, in turn, will continue to call for additional support and investments on a federal level in research and development toward new antibiotics that reflect the value of infection-fighting medicines to individual and public health, and to the practice of modern medicine."