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

Abstract

 

Background

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.

 

Methods

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

 

Results

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).

 

Conclusion

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.

ORIGINAL ARTICLE

 

Authors

 

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

 

*grace.lee@childrens.harvard.edu

 

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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