Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Mar;175(3):347-54.
doi: 10.1001/jamainternmed.2014.5486.

Effect of Medicare's nonpayment for Hospital-Acquired Conditions: lessons for future policy

Teresa M Waters  1 , Michael J Daniels  2 , Gloria J Bazzoli  3 , Eli Perencevich  4 , Nancy Dunton  5 , Vincent S Staggs  6 , Catima Potter  5 , Naleef Fareed  7 , Minzhao Liu  8 , Ronald I Shorr  9
Affiliations

Effect of Medicare's nonpayment for Hospital-Acquired Conditions: lessons for future policy

Teresa M Waters et al. JAMA Intern Med. 2015 Mar.

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 on 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 was not 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.

PubMed Disclaimer

Figures

Figure
Figure. Timing of Centers for Medicare & Medicaid Services Nonpayment Rule and Trends in Hospital-Acquired Conditions
Dashed vertical line indicates the introduction of the Medicare Nonpayment policy in the fourth quarter [Q] of 2008 (A) and October 2008 (B, C, and D).
See this image and copyright information in PMC

Comment in

References

    1. Centers for Medicare & Medicaid Services (CMS), HHS. Medicare program: changes to the hospital inpatient prospective payment systems and fiscal year 2008 rates. Fed Regist. 2007;72(162):47129–48175. - PubMed
    1. Rosenthal MB. Nonpayment for performance? Medicare's new reimbursement rule. N Engl J Med. 2007;357(16):1573–1575. - PubMed
    1. Meddings JA, Reichert H, Rogers MA, Saint S, Stephansky J, McMahon LF. Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis. Ann Intern Med. 2012;157(5):305–312. - PMC - PubMed
    1. McNair PD, Luft HS, Bindman AB. Medicare's policy not to pay for treating hospital-acquired conditions: the impact. Health Aff (Millwood) 2009;28(5):1485–1493. - PubMed
    1. McHugh M, Martin TC, Orwat J, Dyke KV. Medicare's policy to limit payment for hospital-acquired conditions: the impact on safety net providers. J Health Care Poor Underserved. 2011;22(2):638–647. - PubMed

MeSH terms