Impact of Medicare's Hospital-Acquired Condition policy on infections in safety net and non-safety net hospitals.

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

doi:10.1017/ice.2015.38

Abstract

Policymakers may wish to align healthcare payment and quality of care while minimizing unintended consequences, particularly for safety net hospitals. 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. Interrupted time-series design. 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. 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). 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.

Highlights

Louise Elaine Vaz, MD, MPH;[1] Kenneth P
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
We examined the impact on ventilator-associated pneumonia (VAP) rates as a comparison outcome that was not targeted by the Centers for Medicare and Medicaid Services (CMS) policy

Summary

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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. Healthcare-associated infections (HAIs) are a major source of morbidity, mortality, and healthcare costs in the United States.[1,2,3,4] As a result, national and state policymakers, professional societies, and clinical leaders have increasingly focused their energy and efforts on reducing these events to improve patient care.[5,6,7,8] As the largest national payer of healthcare in the United States, the Centers for Medicare and Medicaid Services (CMS) was the first to implement financial disincentives in an attempt to improve quality of care through the Hospital-Acquired Conditions (HAC) policy in 2008. We examined the impact on ventilator-associated pneumonia (VAP) rates as a comparison outcome that was not targeted by the CMS policy

Study Design and Population

Safety Net Definition

Data Analysis

Study Population

Findings

Hospitals reporting CLABSI VAP