CMS nonpayment policy works for preventing targeted infections

HealthDay News -- Hospitals seem to be paying greater attention to preventing hospital-associated infections (HAIs) targeted in the Centers for Medicare and Medicaid Services (CMS) nonpayment policy, study results indicate.

Among 317 infection control specialists surveyed, 81% reported increased attention to hospital-acquired infections as a result of the CMS rule, Grace M. Lee, MD, MPH, from Harvard Medical School in Boston, and colleagues reported in the American Journal of Infection Control.

Instituted in 2008, the CMS policy stipulates that hospitals will not receive additional payment for treating infections that were not present when the patient was admitted. The rule was enacted based on the assumption that hospitals would work harder to eliminate preventable adverse events if CMS no longer offered "perverse incentives" for these complications by paying for them.

Although the current study did not determine whether paying more attention to preventing these infections has actually decreased infection rates, an April 2010 CDC report documented a 32% decrease in bloodstream infections related to central line insertion in hospital patients.

Respondents to the current survey reported that their facilities are now removing urinary catheter and central venous catheters more quickly, and nearly one-third reported increased use of antimicrobial-coated urinary catheters and antiseptic or antimicrobial-impregnated central venous catheters, since adoption of the CMS rule.

Routine urine and blood cultures on admission to establish baseline presence of infection still occurred infrequently (27% and 13%, respectively), but the researchers noted that these tests are not currently recommended in clinical practice guidelines and may not have an impact on overall quality of care.

"For example, patients who receive care in hospitals that routinely culture on admission may be more likely to receive antibiotics without evidence of a true infection, which in turn may lead to other adverse events in patients (e.g., Clostridium difficile infections, allergic reactions) and in the broader community (i.e., rising prevalence of antibiotic-resistant organisms)," they wrote.

Since the inception of the CMS rule, participating hospitals reported only a modest 15% increase in infection control spending and the majority (77%) stated their funding source was stable.

Resource shifting likely explains the majority of the changes documented in the study, the researchers explained. One-third of participating hospitals reported that they are spending less time on HAIs that are not targeted in the rule.

Large hospitals were significantly more likely to shift resources (odds ratio=2.3), whereas hospitals with a front-line staff that were perceived to be receptive to changes in the clinical process were less likely to shift resources (OR=0.5).

The list of infections that CMS will not reimburse for includes catheter-associated urinary tract infections, vascular catheter-associated bloodstream infections, surgical site infections, mediastinitis after CABG surgery, infections acquired during certain orthopedic surgeries and infections from bariatric surgery for morbid obesity.

"The CMS policy of eliminating additional payment for certain HAIs appears to have had a positive impact on hospital infection prevention efforts, yet careful consideration of the potential for unintended consequences is warranted," the researchers wrote.

One researcher disclosed receiving financial compensation for speaking at hospitals, academic medical centers, specialty and state societies, and nonprofit organizations about health care-associated infections.

Lee GM et al. Am J Infect Control. 2012;40(4):314-319.

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