Heather Hsu, MD MPH Assistant Professor of Pediatrics Boston University School of Medicine Boston Medical Center Boston, MA 02118

Federal Incentives Did Not Reduce Catheter Infections in Hospitals

MedicalResearch.com Interview with:

Heather Hsu, MD MPH Assistant Professor of Pediatrics Boston University School of Medicine Boston Medical Center Boston, MA 02118

Dr. Hsu

Heather Hsu, MD MPH
Assistant Professor of Pediatrics
Boston University School of Medicine
Boston Medical Center
Boston, MA 02118

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: In October 2013, the Centers for Medicare and Medicaid Services (CMS) implemented value-based incentive programs to financially reward or penalize hospitals based on quality metrics. Two of these programs – Hospital Value Based Purchasing and the Hospital Acquired Condition Reduction Program – began targeting hospitals’ rates of certain healthcare-associated infections deemed to be preventable in October 2015.

Previous studies demonstrated minimal impact of these value-based payment programs on other measures of hospital processes, patient experience, and mortality. However, their impact on healthcare-associated infections was unknown.

Our goal was to study the association of value-based incentive program implementation with healthcare-associated infection rates, using catheter-associated urinary tract infection in intensive care units (one of the targeted outcomes) as an example.

We found no evidence that federal value-based incentive programs had any measurable association with changes in catheter-associated urinary tract infection rates in the critical care units of US hospitals.

MedicalResearch.com: What should readers take away from your report?

 Response: The good news for patients is that we found modest improvements over time in the use of urinary catheters in the critical care units of U.S hospitals, along with decreased risk for associated urinary tract infections in critically ill hospitalized patients overall.

However, from a policy perspective, we did not find any evidence that the federal payment programs designed to motivate hospitals to engage in further infection prevention efforts made any difference in infection rates or indwelling urinary catheter use.  

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: This study’s findings call into question the effectiveness of value-based incentive programs for catalyzing improvements in care quality and underscore the importance of ongoing rigorous policy evaluations. Given that the total pool of money redistributed to acute care hospitals as a result of these programs will exceed $2 billion in fiscal year 2019, it is important for researchers to continue to investigate their effectiveness and for policymakers and the public to be aware that the programs may not be fulfilling their promise to drive improvements in health.

MedicalResearch.com: Is there anything else you would like to add?

Response: The authors would like to thank all hospitals participating in the Preventing Avoidable Infectious Complications byAdjusting Payment (PAICAP) study that provided data for this analysis.

Disclosures: None of the authors have any conflicts of interest or financial relationships to disclose.

This project was supported by the following grants from the Agency for Healthcare Research and Quality: 2R01HS018414-06 (Grace Lee, MD MPH), T32HS000063 (Heather Hsu, MD MPH.), and K08HS025008 (Chanu Rhee, MD MPH). The funding agency had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare 138 Research and Quality.


Heather E. Hsu, Rui Wang, Maximilian S. Jentzsch, Robert Jin, Donald Goldmann, Chanu Rhee, Grace M. Lee. Association Between Value-Based Incentive Programs and Catheter-Associated Urinary Tract Infection Rates in the Critical Care Setting. JAMA, 2019; 321 (5): 509 DOI: 10.1001/jama.2018.18997

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Last Updated on February 6, 2019 by Marie Benz MD FAAD