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

View Abstract

BACKGROUND

Policymakers may wish to align healthcare payment and quality of care while minimizing unintended consequences, particularly for safety net hospitals.

OBJECTIVE

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

Interrupted time-series design.

SETTING AND PARTICIPANTS

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.

RESULTS

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).

CONCLUSIONS

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.

Investigators
Abbreviation
Infect Control Hosp Epidemiol
Publication Date
2015-06-01
Volume
36
Issue
6
Page Numbers
649-55
Pubmed ID
25732568
Medium
Print-Electronic
Full Title
Impact of Medicare's Hospital-Acquired Condition policy on infections in safety net and non-safety net hospitals.
Authors
Vaz LE, Kleinman KP, Kawai AT, Jin R, Kassler WJ, Grant PS, Rett MD, Goldmann DA, Calderwood MS, Soumerai SB, Lee GM