New CMS Policy Did Not Curb Hospital-Linked Infections, Study Finds

A policy implemented by CMS in 2008 that eliminated payments for certain preventable, hospital-acquired infections resulted in "no significant changes" to rates of two types of infections, according to a study published Thursday in the New England Journal of Medicine, the Wall Street Journal reports (Mathews, Wall Street Journal, 10/10).

Policy Change

Under the rule, Medicare blocked hospital reimbursements for the treatment of certain "conditions that could reasonably have been prevented."

The conditions for which Medicare no longer reimburses hospitals for treatment include:

• Falls;
• Mediastinitis, an infection that can develop after heart surgery;
• Urinary tract infections that result from improper use of catheters;
• Pressure ulcers; and
• Vascular infections that result from improper use of catheters (California Healthline, 8/1/08).

Study Details

For the study, researchers from Harvard Medical School used data from 398 hospitals from January 2006 through March 2011 to compare the infection rates for bloodstream and urinary-tract infections related to catheters before and after the policy went into effect in October 2008.

The researchers also compared those results with rates of ventilator-associated pneumonia, which was not targeted by the policy (Wall Street Journal, 10/10).

The study showed no change in infection rates for catheter-associated bloodstream infections after the policy went into effect and a small but insignificant increase in the rate of urinary tract infections after it went into effect. The study also showed no changes in the rate of ventilator-associated pneumonia (Walsh, MedPage Today, 10/10).

The researchers concluded that there is "no evidence" that the nonpayment policy has had any measurable effect on reducing the rates of those infections (Wall Street Journal, 10/10). However, they noted that the rates for those infections were declining throughout the study period.

Grace Lee, the study's lead author, said the findings could suggest that hospitals already were progressing in efforts to reduce those infections, or that the effect of the financial penalty was limited (McKinney, Modern Healthcare, 10/10).

CMS Response

Officials from CMS said that altogether, their policies to reduce HAIs "are working," noting that a program funded by the Agency for Healthcare Research and Quality was linked to a 40% decrease in catheter-linked bloodstream infections in hospital intensive care units (Wall Street Journal, 10/10).

Meanwhile, Brian Cook, a CMS spokesperson, declined to comment on the study findings, but said the Affordable Care Act strengthens policies to reduce hospital-acquired infections. He added, "We're confident that these policies will improve health care quality and reduce costs" (Appleby, "Capsules," Kaiser Health News, 10/10).