Home E-Weekly October 23, 2012

Do Medicare's Penalties Affect Performance?

Published: October 22, 2012

Four years after the Centers for Medicare and Medicaid Services stopped reimbursing facilities for the treatment of preventable healthcare-associated infections, a team of researchers has raised doubts that the action has had a demonstrable impact on infection rates.

While the infection rates they tracked have fallen, they were not able to correlate them to Medicare's enactment of its financial penalties, according to their study, published in the Oct. 11 issue of the New England Journal of Medicine.

Examining data from 398 hospitals and health systems regarding patients treated between January 2006 and March 2011, researchers from the Harvard Medical School, Institute for Healthcare Improvement, Centers for Disease Control and Prevention and other organizations compared outcomes involving central catheter-associated bloodstream and catheter-associated urinary tract infections (which are included in Medicare's no-pay list) and ventilator-associated pneumonia (which is not).

"We observed decreasing secular trends for both targeted and nontargeted infections long before the policy was implemented," they write, but "[w]e found no evidence that the 2008 CMS policy to reduce payments for central catheter-associated bloodstream infections and catheter-associated urinary tract infections had any measurable effect on infection rates in U.S. hospitals."

The study's findings, which were not affected by a facility's size, ownership, percentage of Medicare patients, or whether its state required infection reporting, point to the importance of determining which regulatory processes have an actual impact on infection rates, say the researchers.

David Bernard

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