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Antimicrobial Stewardship Is Crucial for Value Based Purchasing Programs

The move from fee-for-service models to value-based purchasing in healthcare has significantly elevated the profile of antimicrobial stewardship programs (ASPs). ASPs drive implementation of stewardship policies that ensure proper use of antimicrobials, slow emergence of resistant organisms and improve susceptibility patterns. These programs serve a critical function in meeting quality metrics directly tied to reimbursement rates and financial penalties.1

A robust ASP must understand, measure and report on multiple goals as well as outcome and process measures. Hospitals now must track and report on metrics established by The Joint Commission the Centers for Medicare and Medicaid Services (CMS), , and others. Implementing policies aligned with best practices can lead to savings associated with improved clinical outcomes, such as shorter length of stay and lower readmissions rates, and “improved compliance with outcome measures linked to value-based purchasing may show significant overall savings that dwarf antimicrobial cost savings alone,” according to a report in Clinical Infectious Diseases.

Ad hoc aggregation of data from multiple sources will not be sufficient to support the growing expectations of ASPs, which must have timely and accurate data to effectively move the needle on dozens of outcomes and performance measures. Clinical decision support systems can provide the robust, real-time alerting needed for success by alerting the stewardship team to patients who require their attention, flagging drug/bug mismatches for pharmacists, and prioritizing activities. These systems can enable the stewardship team to readily document interventions along with associated savings and rates of acceptance by provider and unit. Clear and frequent reports allow the team to see what is working and what initiatives need additional resources. The reports engage hospital administration and senior medical staff in the program’s success.

Given the increased importance of antimicrobial stewardship in the current healthcare environment, ASP teams need broad-based support and multidisciplinary participation to achieve their goals. Reports and strategies should be discussed with hospital administration as well as the medication safety, pharmacy and therapeutics, infection control, and clinical quality improvement committees. By working together, these teams can change the culture of the hospital to prioritize antimicrobial stewardship practices, encourage physician compliance, identify new areas of focus, and provide insight into the challenges or necessity of specific initiatives.

In the new world of value-based purchasing, antimicrobial stewardship teams cannot manage all the moving parts of a successful program on their own. Given their importance to hospital finances and reputation, it is in everyone’s interest to support their initiatives and ensure the ASP has the information technology, staff and authority necessary to meet its goals.


  1. Nagle JL, Stevenson JG, Eiland EH III, Kaye KS. Demonstrating the Value of Antimicrobial Stewardship Programs to Hospital Administrators. Clinical Infectious Diseases. 2014. 59(S3):S146-153.


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