To: Jeffrey Epsteinfieevacation©gmail.com]
From: Alice Jacobs
Sent: Tue 2/23/2010 10:04:05 PM
Subject: RE:
<u>imaoe003.emz  imeoe001.emz</u> 

It's expensive to get sick in a hospital. It's cheaper to control infections at the point of admission.

| Infection site | Low estimate avg attributable cost ($, base year) | High estimate avg attributable cost ($, base year) | Low estimate adjusted to 2007 $ (CPI‑U) | High estimate adjusted to 2007 $ (CPI‑U) | Low adjusted to 2007 $ (CPI — Inpatient Hospital Services) | High adjusted to 2007 $ (CPI — Inpatient Hospital Services) |
|---|---:|---:|---:|---:|---:|---:|
| SSI (Surgical site infection) | $10,443 (2005) | $25,546 (2002) | $11,087 | $29,443 | $11,874 | $34,670 |
| CLABSI (Central line‑associated BSI) | $5,734 (2003) | $22,939 (2003) | $6,461 | $25,849 | $7,288 | $29,156 |
| VAP (Ventilator‑associated pneumonia) | $11,897 (1999) | $25,072 (2005) | $14,806 | $27,520 | $19,633 | $28,508 |
| CAUTI (Catheter‑associated UTI) | $589 (1998) | $7,581 (2002) | $749 | $8,832 | $862 | $1,007 |
| CDI (Clostridioides difficile infection) | $5,042 (2003) | $7,179 (2003) | $5,682 | $8,090 | $6,408 | $9,124 |

Legend/notes extracted from figure:
- Base‑year values shown in parentheses.  
- Two 2007 adjustments provided: using CPI‑U and using CPI for Inpatient Hospital Services (each shown for low and high estimates).

Plus the hospital is covered if infections are screened at the door...

- Context: "Point of Admission (POA) — ICD-9-CM Official Coding Guidelines" (slide titled "Impact of Screening at Point of Admission")
- Policy note: Medicare will continue to assign a discharge to a higher‑paying MS‑DRG if the selected condition is present on admission (FY 2008 IPPS: II.D)

| POA indicator | Meaning |
|---|---|
| Y | Condition present on admission |
| W | Not possible to document when onset of condition occurred |
| N | Not present on admission |
| U | Insufficient documentation to determine if present on admission |
| 1 | Exempt from POA reporting |

- Footer: "Confidential" (page -14-)

Thanks for sharing and for thinking of me.

Alice A. Jacobs, M.D.

Chairman & CEO

IntelligentMDx
19 Blackstone Street
Cambridge, MA 02139
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From:Jeffrey Epstein [mailto:jeevacation@gmail.com]
Sent:  Tuesday, February 23, 2010 3:15 PM
To:Alice Jacobs
Subject:

http://www.businessweek.com/lifestyle/content/healthday/636281.html

*********

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