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

Author:

Vaz Louise Elaine,Kleinman Kenneth P.,Kawai Alison Tse,Jin Robert,Kassler William J.,Grant Patricia S.,Rett Melisa D.,Goldmann Donald A.,Calderwood Michael S.,Soumerai Stephen B.,Lee Grace M.

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

Publisher

Cambridge University Press (CUP)

Subject

Infectious Diseases,Microbiology (medical),Epidemiology

Reference46 articles.

1. 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.

2. How Do Black-Serving Hospitals Perform on Patient Safety Indicators?

3. 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.

4. Recommended practices for surveillance: Association for Professionals in Infection Control and Epidemiology (APIC), Inc.

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