Perceived impact of the Medicare policy to adjust payment for health care-associated infections.

Lee GM, Hartmann CW, Graham D, Kassler W, Dutta Linn M, Krein S, Saint S, Goldmann DA, Fridkin S, Horan T, Jernigan J, Jha A. Perceived impact of the Medicare policy to adjust payment for health care-associated infections. American journal of infection control. 2012 May 1; 40(4):314-9.

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Abstract:

BACKGROUND: In 2008, the Centers for Medicare and Medicaid Services (CMS) ceased additional payment for hospitalizations resulting in complications deemed preventable, including several health care-associated infections. We sought to understand the impact of the CMS payment policy on infection prevention efforts. METHODS: A national survey of infection preventionists from a random sample of US hospitals was conducted in December 2010. RESULTS: Eighty-one percent reported increased attention to HAIs targeted by the CMS policy, whereas one-third reported spending less time on nontargeted HAIs. Only 15% reported increased funding for infection control as a result of the CMS policy, whereas most reported stable (77%) funding. Respondents reported faster removal of urinary (71%) and central venous (50%) catheters as a result of the CMS policy, whereas routine urine and blood cultures on admission occurred infrequently (27% and 13%, respectively). Resource shifting (ie, less time spent on nontargeted HAIs) occurred more commonly in large hospitals (odds ratio, 2.3; 95% confidence interval: 1.0-5.1; P = .038) but less often in hospitals where front-line staff were receptive to changes in clinical processes (odds ratio, 0.5; 95% confidence interval: 0.3-0.8; P = .005). CONCLUSION: Infection preventionists reported greater hospital attention to preventing targeted HAIs as a result of the CMS nonpayment policy. Whether the increased focus and greater engagement in HAI prevention practices has led to better patient outcomes is unclear.