The rate of hospital-acquired infections (HAIs) has not been impacted by CMS penalties, according to a study from the Harvard Pilgrim Health Care Institute.
A study of National Healthcare Safety Network (NHSN) data from 2006 to 2011 on HAIs for 398 hospitals from 41 states found no evidence that 2008 CMS policies reducing Medicare payments to hospitals for HAIs had a positive impact. Instead, the study found that infection rates declined steadily throughout this period independent of penalties.
At issue were 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 positive impact of the penalties among hospitals located in states without public reporting of infections or among hospitals with a high proportion of Medicare patients.
Among possible explanations for the findings are the following:
- The CMS measure uses billing codes assigned by hospital staff, and many hospitals may have changed their billing practices rather than reduce true infection rates.
- 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.
- The financial incentives were very small and failed to spark reform. 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 CMS, the Institute for Healthcare Improvement, the Harvard School of Public Health and the CDC.
Source: Harvard Medical School, October 22, 2012
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