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LB 1 Impact of the CMS Policy to Adjust Payment for Healthcare-Associated Infections

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Grace Lee, MD, MPH , Harvard Pilgrim Health Care Institute, Harvard Medical School, and Children's Hospital Boston, Boston, MA
Christine W. Hartmann, PhD , Bedford VA Medical Center; Boston University School of Public Health, Bedford; Boston, MA
William Kassler, MD , Centers for Medicare and Medicaid Services, Boston, MA
Denise Graham , Association for Professionals in Infection Control and Epidemiology, Washington DC, DC
Maya Dutta-Linn, MPH , Harvard Pilgrim Health Care Institute, Boston, MA
Sarah L. Krein, PhD, RN , Veteran Affairs Ann Arbor Healthcare System and University of Michigan, Ann Arbor, MI
Sanjay Saint, MD, MPH , University of Michigan and Ann Arbor VA Medical Center, Ann Arbor, MI
Donald Goldmann, MD , Institute for Healthcare Improvement, Boston, MA
Scott Fridkin, MD , Centers for Disease Control and Prevention, Atlanta, GA
Neil Fishman, MD , University of Pennsylvania School of Medicine, Philadelphia, PA
John Jernigan, MD, MS , Centers for Disease Control and Prevention, Atlanta, GA
Teresa Horan, MPH, CIC , Centers for Disease Control and Prevention, Atlanta, GA
Ashish Jha, MD, MPH , Harvard School of Public Health, Boston, MA
Background: Since Oct 2008, the Centers for Medicare and Medicaid Services (CMS) has been adjusting payment for hospitalizations that result in complications deemed to be preventable, including catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), and surgical site infections (SSIs). 

Objective: To understand the perceived impact of the CMS payment policy on hospital infection prevention efforts. 

Methods: A cross-sectional, national survey of infection preventionists (IPs) working in non-federal, acute-care hospitals.  Surveys were mailed in Dec 2010 to 500 randomly selected U.S. hospitals.  The survey instrument, developed by an expert panel and extensively refined, focused on the impact of the CMS policy on:  1) attention to targeted and non-targeted HAIs; 2) funding for infection control programs; 3) time spent on activities related to surveillance, prevention, and documentation. 

Results: As of Jan 2011, we have received responses from 237 (47%) IPs, though the survey is ongoing.  Of all respondents, 82% report that their hospitals now have a greater focus on HAIs targeted by the CMS policy, with increased surveillance for CAUTIs (59%), CLABSIs (47%), and SSIs (39%). In part due to the CMS policy, IPs felt hospital staff removed urinary catheters (72%) and central lines (51%) more quickly and increasingly used antimicrobial-coated urinary catheters (69%), antiseptic-containing central line dressings (42%), antiseptic-impregnated vascular catheters (60%), and antimicrobial locks for central lines (14%).  IPs reported more time was spent working with physicians to improve the accuracy of documentation of HAIs (53%) and with billing staff to improve the accuracy of coding practices for HAIs (49%).  Some IPs perceived hospital staff also routinely obtained urine (26%) and blood (12%) cultures on admission to document the presence of infections prior to hospitalization.  Despite increased efforts around HAI surveillance, prevention, and documentation, funding for infection control programs remained level (76%) or decreased (8%), though 15% reported increased funding as a direct result of the CMS policy.  Forty-two percent reported their infection control program spent more time on surveillance than prevention efforts, and 33% spent less time preventing HAIs not targeted by the policies.

Conclusions: Our preliminary results suggest the CMS policy has led to its intended impact with enhanced surveillance and prevention efforts for targeted HAIs, although a minority of hospitals may be culturing asymptomatic patients in response to the policy.  In the setting of resource constraints, some hospitals may spend more time on surveillance than prevention, and attention may be diverted away from HAIs not targeted by the policy.   The overall impact of the CMS policy on quality of care and patient outcomes in different types of hospitals warrants careful monitoring.