Impact of Medicare’s Nonpayment Program on Hospital-acquired Conditions

Thirukumaran, Caroline; Glance, Laurent G.; Temkin‐Greener, Helena; Rosenthal, Meredith B.; Li, Yue

doi:10.1097/mlr.0000000000000680

Cited by 10 publications

(4 citation statements)

References 210 publications

(304 reference statements)

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“…Their target HAIs included central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and surgical site infection. However, whether the Centers for Medicare & Medicaid Services' non-payment policy contributes to achieve reduction of HAIs has been inconclusive, with some studies showing a reduction in HAIs and others showing no signi cant relationship with HAIs [23,24]. Drohan and colleagues used a mathematical model to examine how to effectively allocate limited subsidies for IPC [21], showing that a dollar-for-dollar matching grant is most effective in reducing HAIs where hospitals in an area with lower transmission of HAIs preferably receive government subsidies.…”

Section: Discussionmentioning

confidence: 99%

First Nationwide Survey of Infection Prevention and Control among Healthcare Facilities in Japan: Impact of the National Regulatory System

Nomoto

Saito

Ishikane

et al. 2022

Preprint

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Background: Infection prevention and control (IPC) measures in Japan are facilitated by a financial incentive process at the national level, where facilities are categorized into three groups (Tier 1, Tier 2, or no financial incentive). However, its impact on IPC at the facility level using a validated tool has not been measured.Methods: A nationwide cross-sectional study was conducted from August 2019 to January 2020 to evaluate the situation of IPC programs in Japan, using the global IPC Assessment Framework (IPCAF) developed by the World Health Organization. Combined with the information on the national financial incentive system, the demographics of facilities and each IPCAF item were descriptively analyzed. IPCAF scores were analyzed according to the facility level of care and the national financial incentive system for IPC facility status, using Dunn-Bonferroni and Mann-Whitney U tests. Results: Fifty-nine facilities in Japan responded to the IPCAF survey: 34 private facilities (57.6%) and 25 public facilities (42.4%). Of these, 11 (18.6%), 29 (49.2%), and 19 (32.3%) were primary, secondary, and tertiary care facilities, respectively. According to the national financial incentive system for IPC, 45 (76.3%), 11 (18.6%), and three (5.1%) facilities were categorized as Tier 1, Tier 2, and no financial incentive system, respectively. Based on the IPCAF total score, more than half of the facilities were categorized as “Advanced” (n = 31, 55.3%), followed by “Intermediate” (n = 21, 37.5%). The IPCAF total score increased as the facility level of care increased, while no statistically significant difference was identified between the secondary and tertiary care facilities (p= 0.79). There was a significant difference between Tier 1 and Tier 2 for all core components and total scores. Core components 5 (multimodal strategies for implementation of IPC interventions) and 6 (monitoring/audit of IPC and feedback) were characteristically low in Japan with a median score of 65.0 (interquartile range 40.0–85.0) and 67.5 (interquartile range 52.5–87.5), respectively. Conclusions: The national financial incentive system was associated with IPC programs at facility level in Japan. The current financial incentive system does not emphasize the multimodal strategy or cover monitoring/audit, and an additional systematic approach may be required to further promote IPC for more practical healthcare-associated infection prevention.

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Section: Discussionmentioning

confidence: 99%

First Nationwide Survey of Infection Prevention and Control among Healthcare Facilities in Japan: Impact of the National Regulatory System

Nomoto

Saito

Ishikane

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…Our study suggests that changes in payment policy may accelerate PSI rate decreases long term. Other studies suggest that hospitals with a high volume of Medicare patients are more responsive than others to CMS pay-for-performance policies, such as the HACs 33 . It is also possible that there is indeed an accelerated PSI rate decrease after the implementation of payment policy changes but that it is masked by simultaneously increased vigilance in surveillance and reporting that pay-for-performance requires.…”

Section: Discussionmentioning

confidence: 99%

Improvement in Patient Safety May Precede Policy Changes: Trends in Patient Safety Indicators in the United States, 2000–2013

Tedesco¹,

Moghavem

Weng

et al. 2020

J Patient Saf

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Objectives: Quality and safety improvement are global priorities. In the last two decades, the United States has introduced several payment reforms to improve patient safety. The Agency for Healthcare Research and Quality (AHRQ) developed tools to identify preventable inpatient adverse events using administrative data, patient safety indicators (PSIs). The aim of this study was to assess changes in national patient safety trends that corresponded to U.S. pay-for-performance reforms.Methods: This is a retrospective, longitudinal analysis to estimate temporal changes in 13 AHRQ's PSIs. National inpatient sample from the AHRQ and estimates were weighted to represent a national sample. We analyzed PSI trends, Center for Medicaid and Medicare Services payment policy changes, and Inpatient Prospective Payment System regulations and notices between 2000 and 2013.Results: Of the 13 PSIs studied, 10 had an overall decrease in rates and 3 had an increase. Joinpoint analysis showed that 12 of 13 PSIs had decreasing or stable trends in the last 5 years of the study. Central-line blood stream infections had the greatest annual decrease (−31.1 annual percent change between 2006 and 2013), whereas postoperative respiratory failure had the smallest decrease (−3.5 annual percent change between 2005 and 2013). With the exception of postoperative hip fracture, significant decreases in trends preceded federal payment reform initiatives.Conclusions: National in-hospital patient safety has significantly improved between 2000 and 2015, as measured by PSIs. In this study, improvements in PSI trends often proceeded policies targeting patient safety events, suggesting that intense public discourses targeting patient safety may drive national policy reforms and that these improved trends may be sustained by the Center for Medicare and Medicaid Services policies that followed.

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“…1 This report was considered by some to be the impetus of the patient safety movement, 1 resulting in changes to incident reporting requirements, financial penalties related to preventable harm events, and the coalescing of health care organizations, payers, clinicians, researchers, and others around harm reduction iniatives. 2 3 4 5 Despite this focus on patient safety, hospitalized patient harm remains a persistent problem. 3 Makary and Daniel estimated medical errors as the third leading cause of death in the United States, with 251,000 people dying each year.…”

Section: Background and Significancementioning

confidence: 99%

A Scoping Review of Integrated Medical Devices and Clinical Decision Support in the Acute Care Setting

et al. 2022

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Background Seamless data integration between point-of-care medical devices and the electronic health record (EHR) can be central to clinical decision support systems (CDSS). Objective The objective of this scoping review is to (1) examine the existing evidence related to integrated medical devices, primarily medication pump devices, and associated clinical decision support (CDS) in acute care settings and (2) to identify how acute care clinicians may use device CDS in clinical decision-making. The rationale for this review is that integrated devices are ubiquitous in the acute care setting, and they generate data that may help to contribute to the situational awareness of the clinical team necessary to provide individualized patient care. Methods This scoping review was conducted using the Joanna Briggs Institute Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extensions for Scoping Review guidelines. PubMed, CINAHL, IEEE Xplore, and Scopus databases were searched for scholarly, peer-reviewed journals indexed between January 1, 2010 and December 31, 2020. A priori inclusion criteria were established. Results Of the 1,924 articles screened, 18 were ultimately included for synthesis, and primarily included articles on devices such as intravenous medication pumps and vital signs machines. Clinical alarm burden was mentioned in most of the articles, and despite not including the term “medication” there were many articles about smart pumps being integrated with the EHR. The Revised Technology, Nursing & Patient Safety Conceptual Model provided the organizational framework. Ten articles described patient assessment, monitoring, or surveillance use. Three articles described patient protection from harm. Four articles described direct care use scenarios, all of which described insulin administration. One article described a hybrid situation of patient communication and monitoring. Most of the articles described devices and decision support primarily used by registered nurses (RNs). Conclusion The articles in this review discussed devices and the associated CDSS that are used by clinicians, primarily RNs, in the daily provision of care for patients. Integrated device data provide insight into user–device interactions and help to illustrate health care processes, especially the activities when providing direct care to patients in an acute care setting. While there are CDSS designed to support the clinician while working with devices, RNs and providers may disregard this guidance, and defer to their own expertise. Additionally, if clinicians perceive CDSS as intrusive, they are at risk for alarm and alert fatigue if CDSS are not tailored to sync with the workflow of the end-user. Areas for future research include refining inclusion criteria to examine the evidence for devices and their CDS that are most likely used by other groups' health care professionals (i.e., doctors and therapists), using integrated device metadata and deep learning analytics to identify patterns in care delivery, and decision support tools for patients using their own personal data.

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Impact of Medicare’s Nonpayment Program on Hospital-acquired Conditions

Abstract: The Program was associated with decline in incidence of selected HACs, and this decline was variably greater among hospitals with higher MUR.

Cited by 10 publications

References 210 publications

First Nationwide Survey of Infection Prevention and Control among Healthcare Facilities in Japan: Impact of the National Regulatory System

First Nationwide Survey of Infection Prevention and Control among Healthcare Facilities in Japan: Impact of the National Regulatory System

Improvement in Patient Safety May Precede Policy Changes: Trends in Patient Safety Indicators in the United States, 2000–2013

A Scoping Review of Integrated Medical Devices and Clinical Decision Support in the Acute Care Setting

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