title: The Medicare policy of payment adjustment for health care-associated infections: perspectives on potential unintended consequences.
abstract: In 2008, the Centers for Medicare & Medicaid Services introduced a new policy to adjust payment to hospitals for health care-associated infections (HAIs) not present on admission. Interviews with 36 hospital infection preventionists across the United States explored the perspectives of these key stakeholders on the potential unintended consequences of the current policy. Responses were analyzed using an iterative coding process where themes were developed from the data. Participants' descriptions of unintended impacts of the policy centered around three themes. Results suggest the policy has focused more attention on targeted HAIs and has affected hospital staff; relatively fewer systems changes have ensued. Some consequences of the policy, such as infection preventionists having less time to devote to HAIs other than those in the policy or having less time to implement prevention activities, may have undesirable effects on HAI rates if hospitals do not recognize and react to potential time and resource gaps.
authors.affiliation: Bedford VA Medical Center, Bedford, MA 01730, USA. christine.hartmann@va.gov
authors.forename: Christine W
authors.initials: CW
authors.lastname: Hartmann
authors.forename: Timothy
authors.initials: T
authors.lastname: Hoff
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Palmer
authors.forename: Peter
authors.initials: P
authors.lastname: Wroe
authors.forename: M Maya
authors.initials: MM
authors.lastname: Dutta-Linn
authors.forename: Grace
authors.initials: G
authors.lastname: Lee
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000191:economics* / Q000517:prevention & control; D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D006278:Medicare; D008875:Middle Aged; D011787:Quality of Health Care / Q000191:economics; D012051:Reimbursement Mechanisms / Q000331:legislation & jurisprudence*; D014481:United States