Impact of Medicare's Hospital-Acquired Condition Policy on Infections in Safety Net and Non-Safety Net Hospitals

Louise Vaz, Kenneth P. Kleinman, Alison Tse Kawai, Robert Jin, William J. Kassler, Patricia S. Grant, Melisa D. Rett, Donald A. Goldmann, Michael S. Calderwood, Stephen B. Soumerai, Grace M. Lee

Research output: Contribution to journalArticle

14 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)649-655
Number of pages7
JournalInfection Control and Hospital Epidemiology
Volume36
Issue number6
DOIs
StatePublished - 2015

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Iatrogenic Disease
Medicare
Safety
Safety-net Providers
Centers for Medicare and Medicaid Services (U.S.)
Infection
Ventilator-Associated Pneumonia
Quality of Health Care
Centers for Disease Control and Prevention (U.S.)
Cross Infection
Motivation
Delivery of Health Care
Health

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Impact of Medicare's Hospital-Acquired Condition Policy on Infections in Safety Net and Non-Safety Net Hospitals. / Vaz, Louise; Kleinman, Kenneth P.; Kawai, Alison Tse; Jin, Robert; Kassler, William J.; Grant, Patricia S.; Rett, Melisa D.; Goldmann, Donald A.; Calderwood, Michael S.; Soumerai, Stephen B.; Lee, Grace M.

In: Infection Control and Hospital Epidemiology, Vol. 36, No. 6, 2015, p. 649-655.

Research output: Contribution to journalArticle

Vaz, L, Kleinman, KP, Kawai, AT, Jin, R, Kassler, WJ, Grant, PS, Rett, MD, Goldmann, DA, Calderwood, MS, Soumerai, SB & Lee, GM 2015, 'Impact of Medicare's Hospital-Acquired Condition Policy on Infections in Safety Net and Non-Safety Net Hospitals', Infection Control and Hospital Epidemiology, vol. 36, no. 6, pp. 649-655. https://doi.org/10.1017/ice.2015.38
Vaz, Louise ; Kleinman, Kenneth P. ; Kawai, Alison Tse ; Jin, Robert ; Kassler, William J. ; Grant, Patricia S. ; Rett, Melisa D. ; Goldmann, Donald A. ; Calderwood, Michael S. ; Soumerai, Stephen B. ; Lee, Grace M. / Impact of Medicare's Hospital-Acquired Condition Policy on Infections in Safety Net and Non-Safety Net Hospitals. In: Infection Control and Hospital Epidemiology. 2015 ; Vol. 36, No. 6. pp. 649-655.
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AU - Grant, Patricia S.

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N2 - 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.

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