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Effect of nonpayment for preventable infections in U.S. hospitals
Grace M Lee1, Ken Kleinman, Stephen B Soumerai
1Center for Child Health Care Studies, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA. grace.lee@childrens.harvard.edu
Background:
In October 2008, the Centers for Medicare and Medicaid Services (CMS) discontinued additional payments for certain hospital-acquired conditions that were deemed preventable. The effect of this policy on rates of health care-associated infections is unknown.
Methods:
Using a quasi-experimental design with interrupted time series with comparison series, we examined changes in trends of two health care-associated infections that were targeted by the CMS policy (central catheter-associated bloodstream infections and catheter-associated urinary tract infections) as compared with an outcome that was not targeted by the policy (ventilator-associated pneumonia). Hospitals participating in the National Healthcare Safety Network and reporting data on at least one health care-associated infection before the onset of the policy were eligible to participate. Data from January 2006 through March 2011 were included. We used regression models to measure the effect of the policy on changes in infection rates, adjusting for baseline trends.
Results:
A total of 398 hospitals or health systems contributed 14,817 to 28,339 hospital unit-months, depending on the type of infection. We observed decreasing secular trends for both targeted and nontargeted infections long before the policy was implemented. There were no significant changes in quarterly rates of central catheter-associated bloodstream infections (incidence-rate ratio in the postimplementation vs. preimplementation period, 1.00; P=0.97), catheter-associated urinary tract infections (incidence-rate ratio, 1.03; P=0.08), or ventilator-associated pneumonia (incidence-rate ratio, 0.99; P=0.52) after the policy implementation. Our findings did not differ for hospitals in states without mandatory reporting, nor did it differ according to the quartile of percentage of Medicare admissions or hospital size, type of ownership, or teaching status.
Conclusions:
We found no evidence that the 2008 CMS policy to reduce payments for central catheter-associated bloodstream infections and catheter-associated urinary tract infections had any measurable effect on infection rates in U.S. hospitals. (Funded by the Agency for Healthcare Research and Quality.).
Insights
The Centers for Medicare and Medicaid Services (CMS) policy did not reduce hospital-acquired infections. This study found no measurable effect on infection rates after the policy
Area of Science:
- Health Policy Research
- Infectious Disease Epidemiology
- Healthcare Quality Improvement
Background:
- Centers for Medicare and Medicaid Services (CMS) discontinued payments for preventable hospital-acquired conditions in 2008.
- The impact of this policy on healthcare-associated infection (HAI) rates remained unknown.
- Preventable HAIs include central catheter-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI).
Purpose of the Study:
- To evaluate the effect of the 2008 CMS policy on CLABSI and CAUTI rates.
- To compare changes in targeted HAIs with a non-targeted HAI (ventilator-associated pneumonia - VAP).
- To assess if the policy influenced trends in specific healthcare-associated infections.
Main Methods:
- Quasi-experimental design using interrupted time series with a comparison series.
- Analysis of data from 398 hospitals reporting to the National Healthcare Safety Network (2006-2011).
- Regression models adjusted for baseline trends to measure policy impact on infection rates.
Main Results:
- No significant changes observed in quarterly rates for CLABSI (IRR 1.00, P=0.97), CAUTI (IRR 1.03, P=0.08), or VAP (IRR 0.99, P=0.52) post-policy.
- Secular decreasing trends for targeted and non-targeted infections were evident prior to policy implementation.
- Findings were consistent across various hospital types and reporting structures.
Conclusions:
- The 2008 CMS payment policy demonstrated no measurable impact on reducing CLABSI and CAUTI rates in U.S. hospitals.
- Existing downward trends in HAIs were not significantly altered by the policy.
- Further strategies may be needed to effectively reduce hospital-acquired infections.
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