title: Perceived impact of the Medicare policy to adjust payment for health care-associated infections.
abstract: BACKGROUND
  In 2008, the Centers for Medicare and Medicaid Services (CMS) ceased additional payment for hospitalizations resulting in complications deemed preventable, including several health care-associated infections. We sought to understand the impact of the CMS payment policy on infection prevention efforts.
  
  
  METHODS
  A national survey of infection preventionists from a random sample of US hospitals was conducted in December 2010.
  
  
  RESULTS
  Eighty-one percent reported increased attention to HAIs targeted by the CMS policy, whereas one-third reported spending less time on nontargeted HAIs. Only 15% reported increased funding for infection control as a result of the CMS policy, whereas most reported stable (77%) funding. Respondents reported faster removal of urinary (71%) and central venous (50%) catheters as a result of the CMS policy, whereas routine urine and blood cultures on admission occurred infrequently (27% and 13%, respectively). Resource shifting (ie, less time spent on nontargeted HAIs) occurred more commonly in large hospitals (odds ratio, 2.3; 95% confidence interval: 1.0-5.1; P = .038) but less often in hospitals where front-line staff were receptive to changes in clinical processes (odds ratio, 0.5; 95% confidence interval: 0.3-0.8; P = .005).
  
  
  CONCLUSIONS
  Infection preventionists reported greater hospital attention to preventing targeted HAIs as a result of the CMS nonpayment policy. Whether the increased focus and greater engagement in HAI prevention practices has led to better patient outcomes is unclear.
authors.affiliation: Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA 02215, USA. grace.lee@childrens.harvard.edu
authors.forename: Grace M
authors.initials: GM
authors.lastname: Lee
authors.forename: Christine W
authors.initials: CW
authors.lastname: Hartmann
authors.forename: Denise
authors.initials: D
authors.lastname: Graham
authors.forename: William
authors.initials: W
authors.lastname: Kassler
authors.forename: Maya
authors.initials: M
authors.lastname: Dutta Linn
authors.forename: Sarah
authors.initials: S
authors.lastname: Krein
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
authors.forename: Donald A
authors.initials: DA
authors.lastname: Goldmann
authors.forename: Scott
authors.initials: S
authors.lastname: Fridkin
authors.forename: Teresa
authors.initials: T
authors.lastname: Horan
authors.forename: John
authors.initials: J
authors.lastname: Jernigan
authors.forename: Ashish
authors.initials: A
authors.lastname: Jha
mesh_terms: D001291:Attitude of Health Personnel; D003428:Cross Infection / Q000191:economics* / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D017048:Health Care Costs; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics*; D016134:Organizational Policy; D014481:United States