RESUMEN
In October 2008, Medicare ceased additional payment for hospital-acquired conditions not present on admission. We evaluated the policy's differential impact in hospitals with high vs low operating margins. Medicare's payment policy may have had an impact on reducing central line-associated bloodstream infections in hospitals with low operating margins. Infect. Control Hosp. Epidemiol. 2015;37(1):100-103.
Asunto(s)
Infecciones Relacionadas con Catéteres/epidemiología , Infección Hospitalaria/epidemiología , Economía Hospitalaria/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Calidad de la Atención de Salud/economía , Sepsis/epidemiología , Infecciones Relacionadas con Catéteres/economía , Infección Hospitalaria/economía , Humanos , Análisis de Series de Tiempo Interrumpido , Medicare , Política Organizacional , Reembolso de Incentivo , Proveedores de Redes de Seguridad/estadística & datos numéricos , Sepsis/economía , Estados Unidos/epidemiologíaRESUMEN
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. DESIGN: Interrupted time-series design. SETTING AND PARTICIPANTS: 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.