Perceived Impact of the Medicare Policy to Adjust Payment for Health Care-associated Infections

Grace M. Lee MD, MPH; Christine W. Hartmann PhD; Denise Graham BS; William Kassler MD, MPH; Maya Dutta Linn MPH; Sarah Krein PhD, RN; Sanjay Saint MD, MPH; Donald A. Goldmann MD; Scott Fridkin MD; Teresa Horan MPH; John Jernigan MD; Ashish Jha MD, MPH




In 2008, the Centers for Medicare and Medicaid Services (CMS) ceased additional payment for hospitalizations resulting in complications deemed preventable, including several health care-associated infections. We sought to understand the impact of the CMS payment policy on infection prevention efforts.



A national survey of infection preventionists from a random sample of US hospitals was conducted in December 2010.



Eighty-one percent reported increased attention to HAIs targeted by the CMS policy, whereas one-third reported spending less time on nontargeted HAIs. Only 15% reported increased funding for infection control as a result of the CMS policy, whereas most reported stable (77%) funding. Respondents reported faster removal of urinary (71%) and central venous (50%) catheters as a result of the CMS policy, whereas routine urine and blood cultures on admission occurred infrequently (27% and 13%, respectively). Resource shifting (ie, less time spent on nontargeted HAIs) occurred more commonly in large hospitals (odds ratio, 2.3; 95% confidence interval: 1.0-5.1; P = .038) but less often in hospitals where front-line staff were receptive to changes in clinical processes (odds ratio, 0.5; 95% confidence interval: 0.3-0.8; P = .005).



Infection preventionists reported greater hospital attention to preventing targeted HAIs as a result of the CMS nonpayment policy. Whether the increased focus and greater engagement in HAI prevention practices has led to better patient outcomes is unclear.





Grace M. Lee MD, MPH - a,b*

Christine W. Hartmann PhD - c,d

Denise Graham BS - e
William Kassler MD, MPH - f

Maya Dutta Linn MPH - a

Sarah Krein PhD, RN - g

Sanjay Saint MD, MPH - g
Donald A. Goldmann MD - h

Scott Fridkin MD - i

Teresa Horan MPH - i

John Jernigan MD - i
Ashish Jha MD, MPH - j


*[email protected]


Author Affiliations


a - Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA

b - Department of Laboratory Medicine and Division of Infectious Diseases, Children's Hospital Boston, Boston, MA
c - Center for Health Quality, Outcomes, and Economic Research, Bedford VA Medical Center, Bedford, MA

d - Department of Health Policy and Management, School of Public Health, Boston University, Boston, MA

e - Association for Professionals in Infection Control and Epidemiology, Washington, DC
f  - Centers for Medicare and Medicaid Services, New England Region, Boston, MA
g - Ann Arbor VA Medical Center and University of Michigan Medical School, Ann Arbor, MI
h - Institute for Healthcare Improvement, Cambridge, MA
i - Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA

j - Department of Health Policy and Management, Harvard School of Public Health, Boston, MA


Perceived Impact of the Medicare Policy to Adjust Payment for Health Care-associated Infections:  Created on May 11th, 2012.  Last Modified on May 11th, 2012


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