Impact of Medicare's Hospital-Acquired Condition policy on infections in safety net and non-safety net hospitals.
BACKGROUND
Policymakers may wish to align healthcare payment and quality of care while minimizing unintended consequences, particularly for safety net hospitals.


OBJECTIVE
To determine whether the 2008 Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy had a differential impact on targeted healthcare-associated infection rates in safety net compared with non-safety net hospitals.


METHODS
Interrupted time-series design.


METHODS
Nonfederal acute care hospitals that reported central line-associated bloodstream infection and ventilator-associated pneumonia rates to the Centers for Disease Control and Prevention's National Health Safety Network from July 1, 2007, through December 31, 2013.


RESULTS
We did not observe changes in the slope of targeted infection rates in the postpolicy period compared with the prepolicy period for either safety net (postpolicy vs prepolicy ratio, 0.96 [95% CI, 0.84-1.09]) or non-safety net (0.99 [0.90-1.10]) hospitals. Controlling for prepolicy secular trends, we did not detect differences in an immediate change at the time of the policy between safety net and non-safety net hospitals (P for 2-way interaction, .87).


CONCLUSIONS
The Centers for Medicare and Medicaid Services Hospital-Acquired Conditions policy did not have an impact, either positive or negative, on already declining rates of central line-associated bloodstream infection in safety net or non-safety net hospitals. Continued evaluations of the broad impact of payment policies on safety net hospitals will remain important as the use of financial incentives and penalties continues to expand in the United States.
1Division of Pediatric Infectious Diseases,Doernbecher Children's Hospital,Oregon Health & Science University,Portland.
Louise Elaine
LE
Vaz
2Department of Population Medicine,Harvard Medical School & Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
Kenneth P
KP
Kleinman
2Department of Population Medicine,Harvard Medical School & Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
Alison Tse
AT
Kawai
2Department of Population Medicine,Harvard Medical School & Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
Robert
R
Jin
3Centers for Medicare and Medicaid Services,Boston,Massachusetts.
William J
WJ
Kassler
4Methodist Hospital for Surgery,Addison,Texas.
Patricia S
PS
Grant
2Department of Population Medicine,Harvard Medical School & Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
Melisa D
MD
Rett
6Division of Infectious Diseases,Boston Children's Hospital,Boston,Massachusetts.
Donald A
DA
Goldmann
2Department of Population Medicine,Harvard Medical School & Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
Michael S
MS
Calderwood
2Department of Population Medicine,Harvard Medical School & Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
Stephen B
SB
Soumerai
2Department of Population Medicine,Harvard Medical School & Harvard Pilgrim Health Care Institute,Boston,Massachusetts.
Grace M
GM
Lee
D055499:Catheter-Related Infections / Q000191:economics / Q000453:epidemiology; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000706:statistics & numerical data; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology; D004469:Economics, Hospital / Q000706:statistics & numerical data*; D006761:Hospitals / Q000145:classification / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000458:organization & administration / Q000639:trends; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D011050:Policy Making; D058996:Quality Improvement; D012052:Reimbursement, Incentive; D017751:Safety Management / Q000191:economics / Q000639:trends; D014481:United States / Q000453:epidemiology