Medical Research: What is the background for this study? What are the main findings?
Dr. Waters: On October 1, 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy penalizing hospitals for eight complications of hospital care, also known as never events. Under the HACs Initiative, hospitals could no longer justify a higher level Medicare MS-DRG when caring for a patient who developed 1 of the 8 never events. This Initiative was one in a series of CMS payment reforms intended to increase emphasis on value-based purchasing.
We found that Medicare’s nonpayment policy was associated with significant improvements in the time trends for central line associated blood stream infections (CLABSIs) and catheter associated urinary tract infections(CAUTIs). For these outcomes, our data from the National Database of Nursing Quality Indicators showed that introduction of the Medicare policy was associated with an 11% reduction in the rate of change in central line associated blood stream infections and a 10% reduction in the rate of change in CAUTIs. We did not find any relationship between introduction of the policy and significant changes in injurious falls or hospital acquired pressure ulcers (two other important never events covered by the policy). We hypothesized that the Hospital-Acquired Conditions Initiative may have a great effect for conditions where there is strong evidence that better hospital processes yield better outcomes or where processes are more conducive to standardization.
Medical Research: What should clinicians and patients take away from your report?
Dr. Waters: Our evidence indicates that the CMS Hospital-Acquired Conditions Initiative has improved care for patients by significantly reducing hospital-acquired infections.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Waters: Our research suggests that penalties may be most effective where evidence for prevention is clearest or prevention is most conducive to standardization. Further study is warranted to confirm this. If true, research focusing on developing the science of prevention and standardization of approaches is critical for improving patient outcomes.