Effect of medicare's nonpayment for hospital-acquired conditions: Lessons for future policy

Teresa Waters, Michael J. Daniels, Gloria J. Bazzoli, Eli Perencevich, Nancy Dunton, Vincent S. Staggs, Catima Potter, Naleef Fareed, Minzhao Liu, Ronald I. Shorr

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

IMPORTANCE In 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy denying incremental payment for 8 complications of hospital care, also known as never events. The regulation's effect on these events has not been well studied. OBJECTIVE To measure the association between Medicare's nonpayment policy and 4 outcomes addressed by the HACs Initiative: central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure ulcers (HAPUs), and injurious inpatient falls. DESIGN, SETTING, AND PARTICIPANTS Quasi-experimental study of adult nursing units from 1381 US hospitals participating in the National Database of Nursing Quality Indicators (NDNQI), a program of the American Nurses Association. The NDNQI data were combined with American Hospital Association, Medicare Cost Report, and local market data to examine adjusted outcomes. Multilevel models were used to evaluate the effect of Medicare's nonpayment policy never events. EXPOSURES United States hospitals providing treatment for Medicare patients were subject to the new payment policy beginning in October 2008. MAIN OUTCOMES AND MEASURES Changes in unit-level rates of HAPUs, injurious falls, CLABSIs, and CAUTIs after initiation of the policy. RESULTS Medicare's nonpayment policy was associated with an 11% reduction in the rate of change in CLABSIs (incidence rate ratio [IRR], 0.89; 95%CI, 0.83-0.95) and a 10% reduction in the rate of change in CAUTIs (IRR, 0.90; 95%CI, 0.85-0.95), but was not associated with a significant change in injurious falls (IRR, 0.99; 95%CI, 0.99-1.00) or HAPUs (odds ratio, 0.98; 95%CI, 0.96-1.01). Consideration of unit-, hospital-, and market-level factors did not significantly alter our findings.CONCLUSIONS AND RELEVANCE The HACs Initiative was associated with improvements in CLABSI and CAUTI trends, conditions for which there is strong evidence that better hospital processes yield better outcomes. However, the HACs Initiative wanot associated with improvements in HAPU or injurious fall trends, conditions for which there is less evidence that changing hospital processes leads to significantly better outcomes.

Original languageEnglish (US)
Pages (from-to)347-354
Number of pages8
JournalJAMA internal medicine
Volume175
Issue number3
DOIs
StatePublished - Mar 1 2015

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Iatrogenic Disease
Medicare
Catheter-Related Infections
Pressure Ulcer
Urinary Tract Infections
Medical Errors
Nursing
Infection
Incidence
American Nurses' Association
American Hospital Association
Databases
State Hospitals
Hospital Units
Inpatients
Odds Ratio
Outcome Assessment (Health Care)
Costs and Cost Analysis

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Waters, T., Daniels, M. J., Bazzoli, G. J., Perencevich, E., Dunton, N., Staggs, V. S., ... Shorr, R. I. (2015). Effect of medicare's nonpayment for hospital-acquired conditions: Lessons for future policy. JAMA internal medicine, 175(3), 347-354. https://doi.org/10.1001/jamainternmed.2014.5486

Effect of medicare's nonpayment for hospital-acquired conditions : Lessons for future policy. / Waters, Teresa; Daniels, Michael J.; Bazzoli, Gloria J.; Perencevich, Eli; Dunton, Nancy; Staggs, Vincent S.; Potter, Catima; Fareed, Naleef; Liu, Minzhao; Shorr, Ronald I.

In: JAMA internal medicine, Vol. 175, No. 3, 01.03.2015, p. 347-354.

Research output: Contribution to journalArticle

Waters, T, Daniels, MJ, Bazzoli, GJ, Perencevich, E, Dunton, N, Staggs, VS, Potter, C, Fareed, N, Liu, M & Shorr, RI 2015, 'Effect of medicare's nonpayment for hospital-acquired conditions: Lessons for future policy', JAMA internal medicine, vol. 175, no. 3, pp. 347-354. https://doi.org/10.1001/jamainternmed.2014.5486
Waters, Teresa ; Daniels, Michael J. ; Bazzoli, Gloria J. ; Perencevich, Eli ; Dunton, Nancy ; Staggs, Vincent S. ; Potter, Catima ; Fareed, Naleef ; Liu, Minzhao ; Shorr, Ronald I. / Effect of medicare's nonpayment for hospital-acquired conditions : Lessons for future policy. In: JAMA internal medicine. 2015 ; Vol. 175, No. 3. pp. 347-354.
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AU - Daniels, Michael J.

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AU - Perencevich, Eli

AU - Dunton, Nancy

AU - Staggs, Vincent S.

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N2 - IMPORTANCE In 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy denying incremental payment for 8 complications of hospital care, also known as never events. The regulation's effect on these events has not been well studied. OBJECTIVE To measure the association between Medicare's nonpayment policy and 4 outcomes addressed by the HACs Initiative: central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure ulcers (HAPUs), and injurious inpatient falls. DESIGN, SETTING, AND PARTICIPANTS Quasi-experimental study of adult nursing units from 1381 US hospitals participating in the National Database of Nursing Quality Indicators (NDNQI), a program of the American Nurses Association. The NDNQI data were combined with American Hospital Association, Medicare Cost Report, and local market data to examine adjusted outcomes. Multilevel models were used to evaluate the effect of Medicare's nonpayment policy never events. EXPOSURES United States hospitals providing treatment for Medicare patients were subject to the new payment policy beginning in October 2008. MAIN OUTCOMES AND MEASURES Changes in unit-level rates of HAPUs, injurious falls, CLABSIs, and CAUTIs after initiation of the policy. RESULTS Medicare's nonpayment policy was associated with an 11% reduction in the rate of change in CLABSIs (incidence rate ratio [IRR], 0.89; 95%CI, 0.83-0.95) and a 10% reduction in the rate of change in CAUTIs (IRR, 0.90; 95%CI, 0.85-0.95), but was not associated with a significant change in injurious falls (IRR, 0.99; 95%CI, 0.99-1.00) or HAPUs (odds ratio, 0.98; 95%CI, 0.96-1.01). Consideration of unit-, hospital-, and market-level factors did not significantly alter our findings.CONCLUSIONS AND RELEVANCE The HACs Initiative was associated with improvements in CLABSI and CAUTI trends, conditions for which there is strong evidence that better hospital processes yield better outcomes. However, the HACs Initiative wanot associated with improvements in HAPU or injurious fall trends, conditions for which there is less evidence that changing hospital processes leads to significantly better outcomes.

AB - IMPORTANCE In 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy denying incremental payment for 8 complications of hospital care, also known as never events. The regulation's effect on these events has not been well studied. OBJECTIVE To measure the association between Medicare's nonpayment policy and 4 outcomes addressed by the HACs Initiative: central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure ulcers (HAPUs), and injurious inpatient falls. DESIGN, SETTING, AND PARTICIPANTS Quasi-experimental study of adult nursing units from 1381 US hospitals participating in the National Database of Nursing Quality Indicators (NDNQI), a program of the American Nurses Association. The NDNQI data were combined with American Hospital Association, Medicare Cost Report, and local market data to examine adjusted outcomes. Multilevel models were used to evaluate the effect of Medicare's nonpayment policy never events. EXPOSURES United States hospitals providing treatment for Medicare patients were subject to the new payment policy beginning in October 2008. MAIN OUTCOMES AND MEASURES Changes in unit-level rates of HAPUs, injurious falls, CLABSIs, and CAUTIs after initiation of the policy. RESULTS Medicare's nonpayment policy was associated with an 11% reduction in the rate of change in CLABSIs (incidence rate ratio [IRR], 0.89; 95%CI, 0.83-0.95) and a 10% reduction in the rate of change in CAUTIs (IRR, 0.90; 95%CI, 0.85-0.95), but was not associated with a significant change in injurious falls (IRR, 0.99; 95%CI, 0.99-1.00) or HAPUs (odds ratio, 0.98; 95%CI, 0.96-1.01). Consideration of unit-, hospital-, and market-level factors did not significantly alter our findings.CONCLUSIONS AND RELEVANCE The HACs Initiative was associated with improvements in CLABSI and CAUTI trends, conditions for which there is strong evidence that better hospital processes yield better outcomes. However, the HACs Initiative wanot associated with improvements in HAPU or injurious fall trends, conditions for which there is less evidence that changing hospital processes leads to significantly better outcomes.

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