Making the CMS payment policy for healthcare-associated infections work: organizational factors that matter

Area of Science:

• Healthcare Management
• Infectious Disease Prevention
• Hospital Quality Improvement

Background:

• Healthcare-associated infections (HAIs) are a significant cause of morbidity and mortality.
• A 2008 Centers for Medicare and Medicaid Services (CMS) policy financially penalizes hospitals for preventable infections not present on admission.
• The implementation and impact of this policy on hospital practices are not well understood.

Purpose of the Study:

• To examine the role of organizational factors in the effectiveness of the CMS policy as a quality improvement (QI) driver.
• To understand how hospitals are implementing the CMS policy.
• To identify factors that facilitate or impede the policy's role in driving QI.

Main Methods:

• Qualitative study involving interviews with infection preventionists.
• Conducted between late 2009 and early 2010.
• Sample included 36 infection preventionists from 36 hospitals nationwide.

Main Results:

• Preliminary evidence suggests hospital executive behavior, a proactive infection control (IC) culture, and clinical staff engagement positively influence the policy's recognition and acceptance.
• These factors enhance the CMS policy's significance as a QI driver.
• Contextual factors were also identified that may hinder the link between the policy and QI activities.

Conclusions:

• Organizational factors, particularly leadership and culture, are crucial for the CMS policy to effectively drive quality improvement in infection prevention.
• Further research is needed to understand the interplay of contextual factors and their impact on policy implementation.
• Hospitals need to foster supportive environments for infection control to maximize the benefits of financial incentive policies.