Hospital-Acquired Infections Under Pay-for-Performance Systems: an Administrative Perspective on Management and Change

Abstract

Hospital-acquired infections continue to pose a serious threat to patient safety and to the fiscal viability of healthcare facilities under pay-for-performance systems. There is mixed evidence that use of pay-for-performance systems leads to prevention of hospital-acquired conditions. Use of evidence-based guidelines has been shown to reduce hospital-acquired infections. Increasing use of pay-for-performance (PFP) systems results in potential loss of reimbursement for healthcare organizations that fail to prevent hospital-acquired infections (HAI). Healthcare administrators must work with front-line providers and infection control staff to establish and maintain evidence-based infection prevention policy. Additionally, infection control policy should be regularly updated to reflect best practices, and proper change management techniques should be employed in order to mobilize and empower staff to increase their ability to prevent hospital-acquired infections.

Evaluation of the National Healthcare Safety Network standardized infection ratio risk adjustment for healthcare-facility-onset Clostridioides difficile infection in intensive care, oncology, and hematopoietic cell transplant units in general acute-care hospitals

“…Facilities with high HO-CDI SIRs are penalized under 2 CMS pay-for-performance programs: the Hospital Value-Based Purchasing (VBP) Program and the Hospital-Acquired Condition (HAC) Reduction Program. 14 In FY 2018, 1,211 of 2,808 US hospitals (43%) received a net reduction in inpatient reimbursement under the CMS Hospital VBP Program, and an estimated $1.9 billion in CMS reimbursement was withheld from underperforming hospitals and was rewarded to high-performing hospitals, suggesting that the stakes are high. 15,16 Among the 8 facilities included in this study, 3 had their CMS reimbursement reduced, 5 were rewarded under the VBP Program in FY 2018, 2 had their CMS reimbursement reduced, and 6 received no penalty under the HAC reduction program.…”

How Should Economic Analyses Inform Nosocomial Infection Control?

“…In other words, hospitals face both the burden of nosocomial infections and the added financial risks through pay-for-performance systems. 35…”

Physician burnout and healthcare epidemiology: Dual implications worthy of greater scrutiny

“…Administrative healthcare leaders set the vision, provide the resources, and empower the action to achieve metrics in quality and safety. 6 Without executive sponsorship, no infection prevention program will reach its desired goals. 7 Keeping leaders engaged is an ongoing challenge, calling into question the alignment of health system values.…”