A study of National Healthcare Safety Network (NHSN) data from 2006 to 2011 on hospital-acquired infections for 398 hospitals from 41 states finds no evidence that the 2008 Centers for Medicare and Medicaid Services (CMS) policy reducing Medicare payments to hospitals for hospital-acquired infections is having a positive impact.
The study found that infection rates fell steadily throughout the period, unaffected by penalties. The results were published in the October 11 issue of the New England Journal of Medicine.
“As federal policies increasingly use financial disincentives to reduce the risk of hospital-acquired conditions, our data show that this approach has had no effect on rates of targeted health care–associated infection,” said lead author Grace Lee, HMS associate professor of population medicine at the Harvard Pilgrim Health Care Institute.
“Instead, infection rates declined steadily independent of the penalties. As CMS continues to expand this policy to cover Medicaid through the Affordable Care Act, to require public reporting of NHSN data through the Hospital Compare website, and to impose greater financial penalties on hospitals that perform poorly on these measures, careful evaluation is needed to ensure that patient outcomes improve,” said Lee, who is also HMS associate professor of pediatrics at Boston Children’s Hospital.
Researchers examined infection rates for central catheter–associated bloodstream infections and catheter-associated urinary tract infections, both of which CMS targeted for financial penalties beginning in 2008. Infection rates in the study hospitals were compared with rates for ventilator-associated pneumonia, which was not part of the CMS nonpayment policy.
The study found no incremental benefit of the policy among hospitals located in states without public reporting of infections or among hospitals with a high proportion of Medicare patients. Researchers note that there were strong downward secular trends for targeted health care–associated infections well before the implementation or announcement of the CMS policy.
Among possible explanations for the findings, researchers suggest that the CMS measure uses billing codes assigned by hospital staff. Many hospitals may have simply responded by changing their billing practices rather than reducing true infection rates.
Second, some infections targeted by the CMS policy were already areas of focus for other improvement initiatives in the United States, led by the federal government, national organizations that focus on infection prevention and quality improvement, and accrediting agencies. With attention already focused on preventing health care–associated infections, the incremental effort of adjusting payment may have been limited.
Finally, researchers suggest it is possible that the lack of effect was due to the very small financial incentives at stake. Reductions in payment may have been equivalent to as little as 0.6 percent of Medicare revenue for the average hospital; thus, hospitals may not have made additional investments in prevention.
The research was led by HMS researchers at the Harvard Pilgrim Health Care Institute with co-investigators from the Centers for Medicare and Medicaid Services, the Institute for Healthcare Improvement, the Harvard School of Public Health and the Centers for Disease Control and Prevention.
The Agency for Healthcare Research and Quality funded this study.
This story is adapted from a Harvard Pilgrim Health Care Institute news release.
