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CMS’ hospital-acquired conditions payment policy reduces CLABSIs in some facilities
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A CMS policy change halting hospital reimbursement for many preventable hospital-acquired conditions was linked to a decline in central line-associated bloodstream infections at hospitals with lower financial standing, according to recently published data.
“For hospitals with [operating margins (OMs)] in the highest quartile, [central line-associated bloodstream infections (CLABSI)] rates were already declining prior to the [hospital-acquired conditions (HAC)] policy and continued to decline at a similar rate following the policy,” Michael S. Calderwood, MD, MPH, assistant professor at Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote.
Michael S. Calderwood
“In contrast, for hospitals with OMs in the lowest quartile, CLABSI rates appeared to decline following the policy relative to the pre-policy period. This suggests that the policy may have affected hospitals operating at a financial loss differently than hospitals operating at a financial profit.”
Calderwood and colleagues examined changes in CLABSI rates at U.S. hospitals reporting relevant data to the National Healthcare Safety Network during one or more quarters from July 2007 through December 2012. Using demographic and financial data collected through the American Hospital Association Annual Database and the CMS Healthcare Cost Report Information System, the researchers stratified the hospitals into quartiles based on OMs. Hospitals in the upper and lower OM quartiles determined to have acceptable CLABSI reporting trends were enrolled in the final study. The primary area of analysis was quarterly CLABSI rates before and after CMS halted reimbursement for preventable HAC in 2008, with ventilator-associated pneumonia (VAP) rates acting as a control condition due to their exemption from CMS policy.
Among the 358 hospitals reporting CLABSI data, 92 in the lowest quartile and 90 in the highest were included in the analysis. For-profit, nonteaching hospitals were more prevalent among the higher OM institutions, while safety net hospitals were more common among those with lower OMs. Hospitals in the upper quartile reported similarly declining CLABSI rates before and after policy implementation (post-policy vs. pre-policy ratio, 0.99; 95% CI, 0.84-1.17). In contrast, CLABSI rates at lower quartile hospitals shifted from an 8% increase per quarter to a 3% decrease per quarter (post-policy vs. pre-policy ratio, 0.9; 95% CI, 0.84-0.96). Neither group of hospitals showed any evidence for changes in CLABSI reporting practices and VAP rates.
“The current findings suggest that the HAC policy may have improved reported CLABSI rates in a subset of U.S. hospitals operating at a financial loss at the time of policy implementation,” the researchers wrote. “Continued evaluations are needed to assess whether these findings are robust and to ensure payment policies do not result in unintended consequences for vulnerable populations.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures.
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