AHRQ-Funded Articles Find Little to No Impact of CMS Policy on Healthcare-Associated Infections

Two recent articles in the journal Infection Control and Hospital Epidemiology examined the impact of Medicare’s policies on healthcare-associated infections (HAIs) and associated billing. The articles, funded by AHRQ, scrutinized the Centers for Medicare & Medicaid Services’ (CMS) 2008 policies that ended additional payments to hospitals for the costs of care associated with certain “preventable events,” sometimes known as hospital-acquired conditions, including specific HAIs contracted during hospitalization. One paper, “Impact of Medicare’s Hospital-Acquired Condition Policy on Infections in Safety Net and Non–Safety Net Hospitals,” found that the policy had no impact on rates of central line-associated bloodstream infections and ventilator-associated pneumonia in hospitals, which were already declining. The paper andabstract were published in June. The other study, “Impact of the Centers for Medicare and Medicaid Services Hospital-Acquired Conditions Policy on Billing Rates for 2 Targeted Healthcare-Associated Infections,” published with an abstract in April, found that there was an immediate drop in billing rates followed by a slight downward trend for two other HAIs, vascular catheter-associated infections and catheter-associated urinary tract infections, following implementation of the CMS policy.

2015 Jun;36(6):649-55. doi: 10.1017/ice.2015.38. Epub 2015 Mar 3.

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

Vaz LE1, Kleinman KP2, Kawai AT2, Jin R2, Kassler WJ3, Grant PS4, Rett MD2, Goldmann DA5, Calderwood MS2, Soumerai SB2, Lee GM2.

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Abstract

BACKGROUND Policymakers may wish to align healthcare payment and quality of care while minimizing unintended consequences, particularly for safety net hospitals. OBJECTIVE To 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. DESIGN Interrupted time-series design. SETTING AND PARTICIPANTS Nonfederal 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. RESULTS We 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). CONCLUSIONS The 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.