CMS changes in reimbursement for HAIs: setting a research agenda

Area of Science:

• Health Services Research
• Health Policy
• Patient Safety

Background:

• Centers for Medicare and Medicaid Services (CMS) regulations implemented October 1, 2008, deny payment for conditions acquired during hospital stays.
• Three of the 10 covered hospital-acquired conditions are healthcare-associated infections (HAIs), a significant cause of patient harm and mortality.
• HAIs are common, costly, and often preventable inpatient complications.

Purpose of the Study:

• To establish a research agenda focused on the impact of CMS payment policies on the healthcare system.
• To identify strategies for the prevention of healthcare-associated infections.
• To explore the influence of financial incentives on patient safety improvements.

Main Methods:

• An invitational conference was held in April 2009 with 41 national experts and senior researchers.
• A conceptual framework based on behavioral models, organizational theory, and management research was applied.
• Issues and research topics were organized and identified.

Main Results:

• Thirty-two research agenda items were identified and categorized.
• Research areas include incentives, environmental, organizational, clinical, staff, and financial outcomes.
• Methodological challenges associated with studying the policy's impact were discussed.

Conclusions:

• The CMS policy represents a shift towards outcome-based inpatient funding.
• The research agenda is applicable to all hospital-acquired conditions.
• The policy provides a valuable opportunity to study and leverage financial incentives for enhanced patient safety.