Medicare Penalty Appears to Drive Hospital Infection Prevention Efforts

Monitoring for unintended consequences of policies is essential, say study authors

Washington D.C., April 30, 2012 – The 2008 decision by the Centers for Medicare & Medicaid Services (CMS) to cease additional reimbursement to hospitals for certain healthcare-associated infections (HAIs) has led to enhanced focus on infection prevention and changes in practice by front-line staff, according to a national survey of infection preventionists published in the May issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology ( APIC).

A team of researchers and public health policymakers led by Grace M. Lee, MD, MPH, from Harvard Pilgrim Health Care Institute and Harvard Medical School, surveyed head infection preventionists (IPs) at 317 acute care hospitals that were directly impacted by the policy change, which was enacted to motivate hospitals to eliminate preventable infections. According to the survey results, 81 percent of IPs reported increased focus on those HAIs targeted by the policy, namely catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs). 

A majority of IPs reported an increase in surveillance, education, and prevention efforts for HAIs targeted by the CMS policy, particularly for CAUTIs. IPs felt that front-line staff removed urinary (71 percent) and central venous catheters (50 percent) more quickly than before, and increased use of antiseptic-containing dressings for central venous catheters (56 percent) for CLABSI prevention. 

Although the policy did not appear to have a major impact on funding to support infection prevention departments (77 percent), a closer working relationship between infection prevention and quality improvement departments (57 percent) and greater collaboration by interdisciplinary teams to prevent HAIs (65 percent) was noted in response to the CMS policy.

While most of the findings were positive, the survey did identify some unintended consequences of the policy. One-third of respondents said their hospitals needed to shift resources away from non-targeted infections in order to focus on targeted infections. IPs also expressed concern that hospitals focused greater effort on improving physician documentation and coding practices to avoid negative financial penalties, rather than enhancing infection prevention efforts to improve patient outcomes. Finally, a quarter of respondents reported that their hospitals performed unnecessary diagnostic testing upon admission to avoid potential financial penalties.

“The CMS policy of eliminating additional payment for certain HAIs appears to have had a positive impact on hospital infection prevention efforts, yet careful consideration of the potential for unintended consequences is warranted,” say the study authors. “As CMS expands the list of complications for which it will adjust payment and continues to modify its requirements for reporting, it is critical to ensure that policy changes lead to measureable improvements in patient outcomes while minimizing potential unintended consequences.”

This study is one of the first to assess perceived impact of the CMS payment policy on hospital infection prevention efforts as reported by infection preventionists. Infection preventionists were chosen for the study because of their organizational knowledge of infection prevention surveillance, practices, and documentation.

Full text of the article is available to journalists upon request; contact Liz Garman, APIC, +1 202 454 2604, egarman@apic.orgto obtain copies.

 

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About AJIC: American Journal of Infection Control
AJIC: American Journal of Infection Control ( www.ajicjournal.org) covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC - the Association for Professionals in Infection Control and Epidemiology - AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL.

About APIC
APIC’s mission is to create a safer world through prevention of infection. The association’s more than 14,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Follow APIC on Twitter: http://twitter.com/apic.

Notes for editors
“Perceived impact of the Medicare policy to adjust payment for health-care associated infections,” by Grace M. Lee, Christine W. Hartmann, Denise Graham, William Kassler, Maya Dutta Linn, Sarah Krein, Sanjay Saint, Donald A. Goldmann, Scott Fridkin, Teresa Horan, John Jernigan and Ashish Jha appears in the American Journal of Infection Control, Volume 40, Issue 4 (May 2012).

Authors:

Grace M. Lee, MD, MPH (Corresponding Author)
Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School & Department of Laboratory Medicine and Division of Infectious Diseases, Children’s Hospital Boston
Boston, MA, USA

Christine W. Hartmann, PhD
Center for Health Quality, Outcomes, and Economic Research, Bedford VA Medical Center & Department of Health Policy and Management, School of Public Health, Boston University
Boston, MA, USA

Denise Graham, BS
Association for Professionals in Infection Control and Epidemiology (APIC)
Washington, DC, USA

William Kassler, MD, MPH
Centers for Medicare & Medicaid Services, New England Region
Boston, MA, USA

Maya Dutta Linn, MPH
Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School
Boston, MA, USA

Sarah Krein, PhD, RN
Ann Arbor VA Medical Center and University of Michigan Medical School
Ann Arbor, MI, USA

Sanjay Saint, MD, MPH
Ann Arbor VA Medical Center and University of Michigan Medical School
Ann Arbor, MI, USA

Donald A. Goldmann, MD
Institute for Healthcare Improvement
Cambridge, MA, USA

Scott Fridkin, MD
Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention (CDC)
Atlanta, GA, USA

Teresa Horan, MPH
Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention (CDC)
Atlanta, GA, USA

John Jernigan, MD
Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention (CDC)
Atlanta, GA, USA

Ashish Jha, MD, MPH
Department of Health Policy and Management, Harvard School of Public Health
Boston, MA, USA

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Media contact
Liz Garman
+1 202 454 2604
egarman@apic.org