Impact of Medicare’s Hospital-Acquired Condition Policy on Infections in Safety Net and Non–Safety Net Hospitals

Abstract

BACKGROUNDPolicymakers may wish to align healthcare payment and quality of care while minimizing unintended consequences, particularly for safety net hospitals.OBJECTIVETo determine whether the 2008 Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy had a differential impact on targeted healthcare-associated infection rates in safety net compared with non–safety net hospitals.DESIGNInterrupted time-series design.SETTING AND PARTICIPANTSNonfederal acute care hospitals that reported central line–associated bloodstream infection and ventilator-associated pneumonia rates to the Centers for Disease Control and Prevention’s National Health Safety Network from July 1, 2007, through December 31, 2013.RESULTSWe did not observe changes in the slope of targeted infection rates in the postpolicy period compared with the prepolicy period for either safety net (postpolicy vs prepolicy ratio, 0.96 [95% CI, 0.84–1.09]) or non–safety net (0.99 [0.90–1.10]) hospitals. Controlling for prepolicy secular trends, we did not detect differences in an immediate change at the time of the policy between safety net and non–safety net hospitals (P for 2-way interaction, .87).CONCLUSIONSThe Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy did not have an impact, either positive or negative, on already declining rates of central line–associated bloodstream infection in safety net or non–safety net hospitals. Continued evaluations of the broad impact of payment policies on safety net hospitals will remain important as the use of financial incentives and penalties continues to expand in the United States.Infect Control Hosp Epidemiol 2015;00(0): 1–7

Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy

“…The issue of Health Care-Associated Infections (HAIs) continues to be one of the most important public health problems in many countries throughout the world [1,2], and these infections remain a leading cause of morbidity and mortality among hospitalized patients [3] also with an increase consumption of resources and add to cost [4,5]. Central line-associated bloodstream infections (CLABSIs), the majority related with the use of the central venous catheter (CVC) [6,7], are the most important complications in critical care [8–10] and in cancer settings [11,12].…”

Impact of Hospital Operating Margin on Central Line–Associated Bloodstream Infections Following Medicare’s Hospital-Acquired Conditions Payment Policy

“…2016;37(1): [100][101][102][103] In October 2008, the Centers for Medicare & Medicaid Services halted reimbursement for preventable hospital-acquired conditions (HAC), such as central line-associated bloodstream infections (CLABSI). 1 Although our group's prior work found no impact of this policy on already declining secular trends in CLABSI rates reported by US hospitals as a whole 2 or by safety net status, 3 we did not examine whether a hospital's financial operating margin (OM) impacted its response to the HAC policy. Others have demonstrated that hospitals operating at a financial loss have worse performance in terms of quality measures.…”

“…In our primary analysis, we used an interrupted time series design to evaluate the impact of the HAC policy on quarterly CLABSI rates reported by hospitals in the lowest (greatest annual loss) and highest (greatest annual profit) quartiles. 2,3 We hypothesized that the potential for financial penalties might have led to a different response to the HAC policy in hospitals operating at a financial loss. Because ventilatorassociated pneumonia (VAP) was not targeted by the HAC policy, this was used as a control condition.…”

“…We identified hospitals as safety net hospitals if their Medicare Disproportionate Share index was in the highest quartile. 3 We also compared central line-days across the 2 study groups in both the prepolicy period (July 1, 2007-September 30, 2008) and the postpolicy period (October 1, 2008-December 31, 2012), using a t test for comparison.…”

Our New Reality of Public Reporting: Shame Rather Than Blame?

“…Hospitals with a total HAC score above the 75th percentile of the total HAC score distribution are subject to payment reduction [3]. An analysis of the preliminary penalties suggested that major teaching hospitals are 2.9 times more likely to be penalized in this program than nonteaching hospitals [4,5]. Additionally, CMS estimates that 56% of major teaching hospitals will be penalized [2].…”