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. 2015 May;30(5):588-96.
doi: 10.1007/s11606-014-3087-3. Epub 2014 Dec 18.

CMS reimbursement reform and the incidence of hospital-acquired pulmonary embolism or deep vein thrombosis

Risha Gidwani  1 , Jay Bhattacharya
Affiliations

CMS reimbursement reform and the incidence of hospital-acquired pulmonary embolism or deep vein thrombosis

Risha Gidwani et al. J Gen Intern Med. 2015 May.

Abstract

Background: In October 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for the marginal cost of treating certain preventable hospital-acquired conditions.

Objective: This study evaluates whether CMS's refusal to pay for hospital-acquired pulmonary embolism (PE) or deep vein thrombosis (DVT) resulted in a lower incidence of these conditions.

Design: We employ difference-in-differences modeling using 2007-2009 data from the Nationwide Inpatient Sample, an all-payer database of inpatient discharges in the U.S. Discharges between 1 January 2007 and 30 September 2008 were considered "before payment reform;" discharges between 1 October 2008 and 31 December 2009 were considered "after payment reform." Hierarchical regression models were fit to account for clustering of observations within hospitals.

Participants: The "before payment reform" and "after payment reform" incidences of PE or DVT among 65-69-year-old Medicare recipients were compared with three different control groups of: a) 60-64-year-old non-Medicare patients; b) 65-69-year-old non-Medicare patients; and c) 65-69-year-old privately insured patients. Hospital reimbursements for the control groups were not affected by payment reform.

Intervention: CMS payment reform for hospital-based reimbursement of patients with hip and knee replacement surgeries.

Main measures: The outcome was the incidence proportion of hip and knee replacement surgery admissions that developed pulmonary embolism or deep vein thrombosis.

Key results: At baseline, pulmonary embolism or deep vein thrombosis were present in 0.81% of all hip or knee replacement surgeries for Medicare patients aged 65-69 years old. CMS payment reform resulted in a 35% lower incidence of hospital-acquired pulmonary embolism or deep vein thrombosis in these patients (p = 0.015). Results were robust to sensitivity analyses.

Conclusion: CMS's refusal to pay for hospital-acquired conditions resulted in a lower incidence of hospital-acquired pulmonary embolism or deep vein thrombosis after hip or knee replacement surgery. Payment reform had the desired direction of effect.

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Figures

Figure 1.
Figure 1.
Trend, by quarter and year, of adjusted incidence of pulmonary embolism or deep vein thrombosis, Medicare 65–69 and Non-Medicare 60–64.
See this image and copyright information in PMC

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References

    1. Centers for Medicare & Medicaid Services. Hospital-Acquired Conditions (Present on Admission Indicator). 2012; http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcq.... Accessed October 17, 2014.
    1. West N ET, Kirk A. Update on State Government Tracking of Health Care-Acquired Conditions and a Four-State In-Depth Review. June 2012; https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAc.... Accessed October 17, 2014.
    1. Stone PW, Glied SA, McNair PD, et al. CMS changes in reimbursement for HAIs: setting a research agenda. Med Care. 2010;48(5):433. doi: 10.1097/MLR.0b013e3181d5fb3f. - DOI - PMC - PubMed
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    1. American Academy of Orthopedic Surgeons (AAOS). American Academy of Orthopedic Surgeons clinical practice guideline on preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. Rosemont (IL): American Academy of Orthopedic Surgeons (AAOS); 2011. - PubMed

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