Although hospital infection rates continue to decline, Medicare payment penalties are not the cause, according to a the New England Journal of Medicine article titled Effect of Nonpayment for Preventable Infections in U.S. Hospitals.
Beginning October 1, 2008, CMS began to penalize providers for healthcare-associated infections, such as catheter-associated bloodstream infections and catheter-associated urinary tract infections. CMS no longer pays for care associated with these conditions. CMS uses ICD-9-CM codes and present-on-admission indicators to identify preventable complications that should trigger nonpayment.
The article in the New England Journal of Medicine summarizes key points of the Preventing Avoidable Infectious Complications by Adjusting Payment study. Study researchers used data from the National Healthcare Safety Network (NHSN) of the Centers for Disease Control and Prevention to determine whether nonpayment for preventable complications drives better outcomes. The NHSN is a national public health surveillance system for monitoring healthcare–associated infections, and it relies on standardized definitions based on clinical and laboratory data rather than ICD-9-CM codes.
Authors of the study state that any decline in infection rates, as measured according to billing data, may simply reflect changes in coding practices rather than changes in true infection rates. “We are unaware of any data on whether the policy has led to better patient outcomes, as measured on the basis of clinical or laboratory data,” the authors conclude.
The study comes at a crucial juncture, particularly given CMS’ recent decision to expand the policy of nonpayment for preventable complications to Medicaid through the Affordable Care Act.
“As CMS continues to expand this policy to cover Medicaid through the Affordable Care Act, require public reporting of [National Healthcare Safety Network] data through the Hospital Compare website, and impose greater financial penalties on hospitals that perform poorly on those measures, careful evaluation is needed to determine when these programs work, when they have unintended consequences, and what might be done to improve patient outcomes,” the authors conclude.
