Medicare penalty fails to curb hospital-acquired infections

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Four years after the Centers for Medicare & Medicaid Services discontinued payments for preventable hospital-acquired conditions (HACs), new research finds that the policy had no effect on curbing infections, published today in The New England Journal of Medicine.

In October 2008, CMS discontinued additional payments for preventable HACs, according to the American Society for Healthcare Risk Management:

  • Vascular-catheter-associated infection
  • Catheter-associated urinary tract infection
  • Pressure ulcers (stage III and IV)
  • Falls and trauma
  • Surgical site infection after bariatric surgery for obesity
  • Certain orthopedic procedures
  • Bypass surgery (mediastinitis)
  • Administration of incompatible blood
  • Air embolism
  • Foreign object unintentionally retained after surgery

Although the policy only cut back an average of six-tenths of a percent of Medicare revenue, according to The Boston Globe, it was a high-profile policy change toward a pay-for-performance approach to reimbursement.

Researchers looked specifically at data from 2006 through 2011 on central catheter-associated bloodstream infections and catheter-associated urinary tract infections and compared infection data against rates of ventilator-associated pneumonia, which is not under the nonpayment policy.

The result: Researchers 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," study authors wrote.

Still, researchers acknowledged that hospital infection rates are falling overall.

Although infections rates have generally dropped since 2006, it wasn't because of the Medicare penalties, U.S. News and World Report's HealthDay reported.

"It had really nothing to do with the CMS policy," Grace Lee, associate professor at Harvard Pilgrim Health Care Institute and Harvard Medical School, told The Boston Globe.

The downward trend was happening well before policy implementation, due to hospitals taking charge of infections. Hospitals may already haven taken big steps to control infections in the years prior, Lee said.

The overall improved infection rates also may have more to do with rigorous coding procedures, in which case, the improved rates demonstrate better administrative skills rather than better quality, HealthDay noted.

The research strengthens some providers' discontent with the federal agency's "stick" approach, in which CMS halts reimbursement for what it deems preventable or avoidable events.

American Hospital Association Vice President Nancy Foster told The Wall Street Journal the study should make policy makers "take a step back and say, 'Are payment penalties the right way to go; do they actually add to the efforts?' on reducing infections and other hospital-acquired conditions?"

For more information:
- check out the NEJM study
- here's the American Society for Healthcare Risk Management white paper (.pdf)
- read the U.S. News and World Report's Health Day article
- here's the Boston Globe article
- see the Wall Street Journal article

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