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Hospital onset bacteremia and fungemia should be a pay-for performance measure: a pro/con debate
Gregory M Schrank1, Theresa Madaline2
1Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
Abstract:
Healthcare-associated infections (HAIs) result in substantial patient harm and avoidable costs. Pay-for-performance programs (PFP) through the Centers for Medicare and Medicaid Services (CMS) have resulted in reductions of HAIs like central line-associated bloodstream infections (CLABSI) and methicillin-resistant Staphylococcus aureus bacteremia, through robust infection prevention programs and practices. Hospital Onset Bacteremia and Fungemia (HOB) is proposed as an alternative quality measure for public reporting and PFP, and was endorsed by the National Quality Forum in 2022. This broad measure is designed as an electronic quality measure that avoids manual abstraction and excludes risk adjustment. HOB would substantially expand the scope of focus of existing bloodstream infection measurement, and is currently being considered for voluntary reporting in 2025. In this article, we provide arguments for and against adopting HOB as a PFP measure linked to CMS payments.
Insights
Hospital Onset Bacteremia and Fungemia (HOB) is a proposed quality measure to improve healthcare-associated infection (HAI) prevention. This article examines arguments for and against its adoption in pay-for-performance programs.
Area of Science:
- Infectious Diseases
- Healthcare Quality Improvement
- Health Policy
Background:
- Healthcare-associated infections (HAIs) cause significant patient harm and financial burdens.
- Pay-for-performance (PFP) programs, like those from the Centers for Medicare and Medicaid Services (CMS), have successfully reduced specific HAIs such as central line-associated bloodstream infections (CLABSI).
Purpose of the Study:
- To evaluate the proposed Hospital Onset Bacteremia and Fungemia (HOB) measure as an alternative quality metric for public reporting and PFP.
- To present arguments for and against the adoption of HOB as a CMS-linked PFP measure.
Main Methods:
- The article discusses the characteristics of the HOB measure, including its design as an electronic quality measure that bypasses manual abstraction and risk adjustment.
- It reviews the potential impact of HOB on the scope of bloodstream infection measurement.
Main Results:
- The HOB measure was endorsed by the National Quality Forum in 2022 and is being considered for voluntary reporting in 2025.
- The discussion covers the advantages and disadvantages of implementing HOB within CMS payment structures.
Conclusions:
- The adoption of HOB as a PFP measure presents a significant expansion of current HAI quality measurement.
- Careful consideration of arguments for and against HOB is necessary before its integration into CMS payment programs.
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