Nonpayment policy not impacting infection rates: study

The federal government's 4-year-old nonpayment policy for hospital-acquired conditions has had no measurable effect on rates of several types of healthcare-associated infections specifically targeted by the program, according to a study published in the New England Journal of Medicine.

In October 2008, the CMS stopped reimbursing hospitals for 12 hospital-acquired conditions, including patient falls, late-stage pressure ulcers, air embolisms and certain healthcare-associated infections.

Using data gathered before and after the CMS' policy change, researchers found no evidence that nonpayment had lowered rates of central line-associated bloodstream infections or catheter-associated urinary tract infections.

Rates of such infections were on a downward trend throughout the study period, the authors said, but those drops could not be attributed to the federal government's hospital-acquired conditions program.

They offered a number of possible explanations for their findings, including the CMS' reliance on administrative data.

“With billing data as the metric, hospitals may focus greater effort on improving documentation and coding of infections as 'present on admission' than on preventing infections,” they wrote. “Thus, billing data may not reflect the underlying quality of care at the institution, and the policies that rely on such data may be less effective.”

Central line-associated bloodstream infections or catheter-associated urinary tract infections have also been targeted by many other initiatives, led by both public and private groups. “With attention already focused on preventing healthcare-associated infections, the incremental effect of adjusting payment may have been limited,” the authors wrote.

A previous study, published in May in the American Journal of Infection Control and authored by several of the same researchers, found that hospitals were increasing infection surveillance and prevention efforts in response to the CMS' nonpayment policy.