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

Published online by Cambridge University Press:  03 March 2015

Louise Elaine Vaz ,
Kenneth P. Kleinman ,
Alison Tse Kawai ,
Robert Jin ,
William J. Kassler ,
Patricia S. Grant ,
Melisa D. Rett ,
Donald A. Goldmann ,
Michael S. Calderwood  and
Stephen B. Soumerai
...Show all authors
Louise Elaine Vaz*
Affiliation:
Division of Pediatric Infectious Diseases, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland
Kenneth P. Kleinman
Affiliation:
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Alison Tse Kawai
Affiliation:
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Robert Jin
Affiliation:
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
William J. Kassler
Affiliation:
Centers for Medicare and Medicaid Services, Boston, Massachusetts
Patricia S. Grant
Affiliation:
Methodist Hospital for Surgery, Addison, Texas Association for Professionals in Infection Control and Epidemiology, Washington, DC
Melisa D. Rett
Affiliation:
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Donald A. Goldmann
Affiliation:
Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts Institute for Healthcare Improvement, Cambridge, Massachusetts
Michael S. Calderwood
Affiliation:
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts Brigham and Women’s Hospital, Boston, Massachusetts
Stephen B. Soumerai
Affiliation:
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Grace M. Lee
Affiliation:
Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
*
Address correspondence to Louise Vaz, MD, MPH, Doernbecher Children’s Hospital, Oregon Health & Science University, Mail Code CDRC-P, 707 SW Gaines St, Portland, OR 97239 (vaz@ohsu.edu).
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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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 6 , June 2015 , pp. 649 - 655
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

1. Stone, PW. Economic burden of healthcare-associated infections: an American perspective. Expert Rev Pharmacoecon Outcomes Res 2009;9:417–422.CrossRefGoogle ScholarPubMed
2. Reed, D, Kemmerly, SA. Infection control and prevention: a review of hospital-acquired infections and the economic implications. Ochsner J 2009;9:27–31.Google Scholar
3. Zimlichman, E, Henderson, D, Tamir, O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039–2046.CrossRefGoogle ScholarPubMed
4. Stone, PW, Pogorzelska-Maziarz, M, Herzig, CT, et al. State of infection prevention in US hospitals enrolled in the National Health and Safety Network. Am J Infect Control 2014;42:94–99.Google Scholar
5. Berenholtz, SM, Lubomski, LH, Weeks, K, et al. Eliminating central line–associated bloodstream infections: a national patient safety imperative. Infect Control Hosp Epidemiol 2014;35:56–62.Google Scholar
6. Department of Health and Human Services. Prevent health care–associated infections (HAIs) | Health.gov (ODPHP). Webpage. 2014. Available at: http://www.health.gov/hai/prevent_hai.asp. Accessed March 5, 2014.Google Scholar
7. Pronovost, PJ, Marsteller, JA, Goeschel, CA. Preventing bloodstream infections: a measurable national success story in quality improvement. Health Aff 2011;30:628–634.Google Scholar
8. Pronovost, P, Goeschel, C, Colantuoni, E, et al. Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ 2010;340:c309.CrossRefGoogle ScholarPubMed
9. Straube, B, Blum, JD. The policy on paying for treating hospital-acquired conditions: CMS officials respond. Health Aff 2009;28:1494–1497.Google Scholar
10. Centers for Medicare and Medicaid Services. CMS overview: hospital-acquired conditions (present on admission indicator). Webpage. 2014. Available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/index.html. Accessed May 22, 2014.Google Scholar
11. Institute of Medicine. America’s Health Care Safety Net: Intact but Endangered. Washington, DC: National Academies Press, 2000:1–16.Google Scholar
12. Ly, DP, Lopez, L, Isaac, T, Jha, AK. How do black-serving hospitals perform on patient safety indicators? Med Care 2010;48:1133–1137.CrossRefGoogle ScholarPubMed
13. Werner, RM, Goldman, LE, Dudley, RA. Comparison of change in quality of care between safety-net and non–safety-net hospitals. JAMA 2008;299:2180–2187.CrossRefGoogle ScholarPubMed
14. Hoff, T, Hartmann, CW, Soerensen, C, Wroe, P, Dutta-Linn, M, Lee, G. Making the CMS payment policy for healthcare-associated infections work: organizational factors that matter. J Healthc Manag 2011;56:319–335.Google Scholar
15. Krein, SL, Kowalski, CP, Hofer, TP, Saint, S. Preventing hospital-acquired infections: a national survey of practices reported by US hospitals in 2005 and 2009. J Gen Intern Med 2012;27:773–779.Google Scholar
16. Brown, J, Doloresco, F III, Mylotte, JM. “Never events”: not every hospital-acquired infection is preventable. Clin Infect Dis 2009;49:743–746.Google Scholar
17. Lee, TB, Montgomery, OG, Marx, J, Olmsted, RN, Scheckler, WE. Recommended practices for surveillance: Association for Professionals in Infection Control and Epidemiology (APIC), Inc. Am J Infect Control 2007;35:427–440.Google Scholar
18. Centers for Disease Control and Prevention. CDC—tracking infections in acute care hospitals/facilities—NHSN. Webpage. 2014. Available at: http://www.cdc.gov/nhsn/acute-care-hospital/index.html. Accessed July 28, 2014.Google Scholar
19. Harvard Pilgrim Health Care Institute. The PAICAP Project | Preventing Avoidable Infectious Complications by Adjusting Payment. Webpage. 2014. Available at: http://paicap.org/. Accessed March 12, 2014.Google Scholar
20. Lee, GM, Kleinman, K, Soumerai, SB, et al. Effect of nonpayment for preventable infections in US hospitals. N Engl J Med 2012;367:1428–1437.Google Scholar
21. Centers for Medicare and Medicaid Services. Inpatient PPS disproportionate share hospital. Webpage. 2013. Available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/dsh.html. Accessed December 15, 2013.Google Scholar
22. Centers for Disease Control and Prevention. CDC—about NHSN. Webpage. 2013. Available at: http://www.cdc.gov/nhsn/about.html. Accessed August 23, 2013.Google Scholar
23. Centers for Medicare and Medicaid Services. Overview page for the Acute Inpatient PPS. Webpage. 2013. Available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html. Accessed March 12, 2014.Google Scholar
24. American Hospital Association. American Hospital Association annual survey database fiscal year 2009. 2009. Available at: http://www.aha.org/research/policy/2009.shtml. Accessed June 1, 2014.Google Scholar
25. Centers for Medicare and Medicaid Services. Fiscal year (FY) inpatient prospective payment system (IPPS). MLN Matters 2008;MM6189:1-28. Available at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM6189.pdf. Accessed February 15, 2015.Google Scholar
26. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.CrossRefGoogle ScholarPubMed
27. Meddings, J, Saint, S, McMahon, LF. Hospital-acquired catheter-associated urinary tract infection: documentation and coding issues may reduce financial impact of Medicare’s new payment policy. Infect Control Hosp Epidemiol 2010;31:627–633.Google Scholar
28. Centers for Medicare and Medicaid Services. Special treatment: hospitals that serve a disproportionate share of low-income patients. Fed Regist 2010;412:590–595.Google Scholar
29. Centers for Medicare and Medicaid Services. MEDPAR data set. Website Medicare.gov. 2009. Available at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MedicareFeeforSvcPartsAB/MEDPAR.html. Accessed March 12, 2014.Google Scholar
30. Centers for Medicare and Medicaid Services. Historical impact files for FY 2009. Webpage. 2009. Available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Historical-Impact-Files-for-FY-1994-through-Present.html. Accessed March 12, 2014.Google Scholar
31. Chatterjee, P, Joynt, KE, Orav, EJ, Jha, AK. Patient experience in safety-net hospitals: implications for improving care and value-based purchasing. Arch Intern Med 2012;172:1204–1210.Google Scholar
32. Jha, AK, DesRoches, CM, Shields, AE, et al. Evidence of an emerging digital divide among hospitals that care for the poor. Health Aff 2009;28:w1160–w1170.Google Scholar
33. Clarke, S, Donaldson, N. Nurse staffing and patient care quality and safety. In: Hughes RG ed. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality, 2008, Available at: http://www.ncbi.nlm.nih.gov/pubmed/21328775. Accessed January 20, 2015.Google Scholar
34. SAS Institute. SAS (version 9.4) statistical software. Cary, NC; 2014.Google Scholar
35. McNair, PD, Luft, HS, Bindman, AB. Medicare’s policy not to pay for treating hospital-acquired conditions: the impact. Health Aff 2009;28:1485–1493.Google Scholar
36. Essential Hospitals. Hospital-acquired infections (HAI) archives | America’s Essential Hospitals. Webpage. 2014. Available at: http://essentialhospitals.org/tag/hospital-acquired-infections-hai/. Accessed June 18, 2014.Google Scholar
37. Calderwood, MS, Kleinman, K, Soumerai, SB, et al. Impact of Medicare’s payment policy on mediastinitis following coronary artery bypass graft surgery in US hospitals. Infect Control Hosp Epidemiol 2014;35:144–151.Google Scholar
38. Naessens, J. Identifying adverse events not present on admission: can we do it? AHRQ Perspective. Webpage. 2008. Available at: http://webmm.ahrq.gov/perspective.aspx?perspectiveID=66. Accessed June 30, 2014.Google Scholar
39. Harris, JM, Gay, JC, Neff, JM, Patrick, SW, Sedman, A. Comparison of administrative data versus infection control data in identifying central line–associated bloodstream infections in children’s hospitals. Hosp Pediatr 2013;3:307–313.CrossRefGoogle ScholarPubMed
40. Johnson, T, Kane, JM, Odwazny, R, McNutt, R. Association of the position of a hospital-acquired condition diagnosis code with changes in Medicare severity diagnosis-related group assignment. J Hosp Med 2014;9:707–713.Google Scholar
41. McNutt, R, Johnson, TJ, Odwazny, R, et al. Change in MS-DRG assignment and hospital reimbursement. Qual Manag Heal Care 2010;19:17–24.CrossRefGoogle ScholarPubMed
42. Lee, GM, Hartmann, CW, Graham, D, et al. Perceived impact of the Medicare policy to adjust payment for health care–associated infections. Am J Infect Control 2012;40:314–319.CrossRefGoogle ScholarPubMed
43. Hartmann, CW, Hoff, T, Palmer, JA, Wroe, P, Dutta-Linn, MM, Lee, G. The Medicare policy of payment adjustment for health care–associated infections: perspectives on potential unintended consequences. Med Care Res Rev 2012;69:45–61.CrossRefGoogle ScholarPubMed
44. Coughlin, TA, Long, SK, Sheen, E, Tolbert, J. How five leading safety-net hospitals are preparing for the challenges and opportunities of health care reform. Health Aff 2012;31:1690–1697.Google Scholar
45. Summer, L. The Impact of the Affordable Care Act on the Safety Net. Washington, DC: Academy Health, 2011:1–6. Available at: http://www.academyhealth.org/files/FileDownloads/AHPolicybrief_Safetynet.pdf Google Scholar
46. Bachrach, D, Braslow, L, Karl, A, Bruce, S. Toward a High Performance Health Care System for Vulnerable Populations: Funding for Safety-Net Hospitals Prepared for the Commonwealth Fund Commission on a High Performance Health System. The Commonwealth Fund. Website. 2012. Available at: http://www.commonwealthfund.org/publications/fund-reports/2012/mar/vulnerable-populations. Accessed February 14, 2015.Google Scholar