Patient Care

Effect of Nonpayment on Nosocomial Infection Rates in U.S. Hospitals


 

Clinical question: Did the 2008 Center for Medicare & Medicaid Services (CMS) policy denying additional payment for hospital-acquired conditions result in decreased rates of nosocomial infections?

Background: In an effort to curtail preventable complications, CMS implemented a policy of nonpayment for certain healthcare-acquired conditions beginning in October 2008. The effect of this policy on rates of nosocomial infections, including central venous catheter-associated bloodstream infections and catheter-associated urinary tract infections, is unknown.

Study design: Quasi-experimental.

Setting: Data collected from 398 hospitals participating in the National Healthcare Safety Network of the Centers for Disease Control and Prevention.

Synopsis: Investigators analyzed rates of nosocomial infections in participating hospitals before and after implementation of the 2008 nonpayment policy. The rates of decline in central venous catheter infections were not significantly different in the pre-implementation and post-implementation periods (4.8% per quarter and 4.7% per quarter, respectively; incidence-rate ratio 1.0; P=0.97). Similar results were found with regard to catheter-associated UTIs before and after policy initiation (3.9% per quarter and 0.9% per quarter, incidence-rate ratio 1.03; P=0.08). Results did not vary between states with and without mandatory reporting of nosocomial infections.

While this study’s broad scope limits the ability to draw firm conclusions, it does highlight the need for careful evaluation and quantification of the outcomes resulting from CMS’ expansion of policies for financial incentives and disincentives.

Bottom line: National rates of decline in nosocomial infections were unchanged before and after implementation of CMS’ nonpayment policy in 2008.

Citation: Lee GM, Kleinman K, Soumerai SB, et al. Effect of nonpayment for preventable infections in U.S. hospitals. N Engl J Med. 2012;367:1428-1437

Recommended Reading

Hospitalists Get Answers to Tough Healthcare Questions
The Hospitalist
HMX Term of the Month: CMS 1500
The Hospitalist
New Codes Bridge Hospitals' Post-Discharge Billing Gap
The Hospitalist
Multidisciplinary Palliative-Care Consults Help Reduce Hospital Readmissions
The Hospitalist
VTE Pathway Improves Outcomes for Uninsured Patients
The Hospitalist
Well-Designed IT Systems Essential to Healthcare Integration
The Hospitalist
Win Whitcomb: Mortality Rates Become a Measuring Stick for Hospital Performance
The Hospitalist
ONLINE EXCLUSIVE: Billing Expert Explains Why Documentation, Education, and Feedback Are Crucial to Reimbursement
The Hospitalist
ONLINE EXCLUSIVE: CogentHMG hospitalist explains how hospitalists can prepare for Value-Based Purchasing at hospital, individual level
The Hospitalist
12 Things Hospitalists Need to Know About Billing and Coding
The Hospitalist
   Comments ()