Rate of Hospital-Acquired Infections Not Impacted by Penalties

A study published last week in the New England Journal of Medicine claims that hospital-acquired conditions (HAC) have not been reduced as a result of the Center for Medicare and Medicaid Services’ (CMS) policy to deny payment for certain of these infections. This policy took effect for discharges occurring after October 2008 and provides that CMS will not pay for specified HACs that are not present upon the patient’s admission to the facility but develop as a secondary condition. These HACs include bloodstream and urinary tract infections associated with central line and catheter use.

The policy was developed by CMS in response to growing worry about the prevalence of HACs–an estimated 5 percent of hospitalized patients acquire one. The high rate of HACs costs an additional $33 billion annually. The Deficit Reducation Act (DRA) of 2005 defines a HAC as a condition that is: (1) high cost, high volume, or both; (2) result in the assignment of a case to a diagnosis-related group (DRG) that has a higher payment when present as a secondary diagnosis; and (3) could have reasonably been prevented through the application of evidence-based guidelines.

CMS’ goal was to spark a change to hospital conduct, forcing them to implement preventative measures or risk financial losses. Since these HACs are considered avoidable events, CMS determined that institutions should not receive more program money for failing to prevent them.

The study, led by Harvard professor, Dr. Grace Lee, compared data regarding catheter-related bloodstream and urinary tract infections with data regarding ventilator-associated pneumonia–another HAC that is still reimbursed by CMS–from 398 hospitals nationwide. Patterns for all the HACs were similar, showing an overall decline in infection rates both prior to and subsequent to the implementation of the CMS policy. Some hospitals even demonstrated a greater decline in infection rates before the policy was implemented.

The conclusion: “The financial penalty did not further reduce infection rates, which were already going down because of multitude of (infection control) campaigns and interventions that were already ongoing,” stated Dr. Lee. These findings are consistent with an American Hospital Association study, as well as with data from other studies. The key to reducing HACs has been team-based patient safety initiatives, not payment denials.

CMS stands by its HAC non-payment policy and its potential to lower health care costs while improving quality. Lisa McGiffert of Consumers Union pointed out that the study relied on data from hospitals that voluntarily reported their HAC information and may have been ahead of the curve when it came to patient safety efforts. Other hospitals that had not voluntarily reported their data may have presented different results, seeing more of a decline in infections after being forced to pay attention to HACs by the prospect of non-payment.