Reimbursement Policy for HAI: A Research Agenda

Abstract

Background: Annually in the United States there are nearly 2 million patients stricken with a healthcare associated infection (HAI), which translates to more than 5 percent of all hospitalized patients. Nearly 100,000 of the patients with HAIs are estimated to die. The annual cost of HAIs in the US is estimated to be greater than 25 billion dollars. With the pervasiveness of HAIs that are largely preventable and the associated costs, it is not surprising that these infections were targeted for nonpayment. As part of the Deficit Reduction Act effective October 2008, Medicare no longer pays for many potentially preventable types of HAI.Purpose: To develop a research agenda to evaluate the impact of the new HAI non-reimbursement policy.Methodology: A daylong invitational conference was convened with a group of 39 national experts who discussed the issues and generated a research agenda. Participants' interdisciplinary expertise included nursing, quality, epidemiology, economics, health services research and policy.Findings: All agreed that there will be intended (eg, hospitals invest in infection prevention and HAIs are reduced) and unintended consequences (eg, poor patient care such as overtreatment with antibiotics or change in coding practices with no change in patient care) The research agenda that emerged included applicable conceptual frameworks (eg, behavioral change and organizational theory), methodologic issues (eg, HAI definitions and measurement, risk-adjustment, process measures, interdisciplinary teams, and mixed methodologies) and specific research topics (eg, identifying best practices, monitoring coding practices and examining financial impact).Summary Concluding Statement: Payment reform is happening and must be evaluated. Nursing leadership should play a key role in all phases of reform (planning, implementation and evaluation) This research agenda developed is likely to be applicable to reform related many different clinical issues. Background: Annually in the United States there are nearly 2 million patients stricken with a healthcare associated infection (HAI), which translates to more than 5 percent of all hospitalized patients. Nearly 100,000 of the patients with HAIs are estimated to die. The annual cost of HAIs in the US is estimated to be greater than 25 billion dollars. With the pervasiveness of HAIs that are largely preventable and the associated costs, it is not surprising that these infections were targeted for nonpayment. As part of the Deficit Reduction Act effective October 2008, Medicare no longer pays for many potentially preventable types of HAI. Purpose: To develop a research agenda to evaluate the impact of the new HAI non-reimbursement policy. Methodology: A daylong invitational conference was convened with a group of 39 national experts who discussed the issues and generated a research agenda. Participants' interdisciplinary expertise included nursing, quality, epidemiology, economics, health services research and policy. Findings: All agreed that there will be intended (eg, hospitals invest in infection prevention and HAIs are reduced) and unintended consequences (eg, poor patient care such as overtreatment with antibiotics or change in coding practices with no change in patient care) The research agenda that emerged included applicable conceptual frameworks (eg, behavioral change and organizational theory), methodologic issues (eg, HAI definitions and measurement, risk-adjustment, process measures, interdisciplinary teams, and mixed methodologies) and specific research topics (eg, identifying best practices, monitoring coding practices and examining financial impact). Summary Concluding Statement: Payment reform is happening and must be evaluated. Nursing leadership should play a key role in all phases of reform (planning, implementation and evaluation) This research agenda developed is likely to be applicable to reform related many different clinical issues.