Medicare Shift Fails to Cut Hospital Infections
A high-profile Medicare policy that sought to reduce certain hospital-acquired infections by cutting payments tied to treating them turned out to have no impact, according to a new study in the New England Journal of Medicine.
The study, which looked at the effect of the 2008 payment change on bloodstream and urinary-tract infections related to catheters, found "no evidence" that the shift had any measurable impact on the infections, which were already decreasing before the change went into effect. The study follows other research that has cast doubt on the effectiveness of some efforts to tie reimbursement to quality-improvement efforts in health care, an approach that is being considerably ramped up under the federal health overhaul.
The Medicare policy, mandated by federal law, was supposed to ensure that hospitals didn't get paid additional money to treat hospital-acquired conditions that were deemed to be preventable.
Researchers used data from 398 hospitals, spanning from January 2006 through March 2011. They compared the infection rates before the policy started in October 2008 to the period afterward. They also compared those results to another condition, ventilator-associated pneumonia, which wasn't targeted by the payment change. After the shift, there were "no significant changes" in the rates of any of the three conditions, the study found.
The results didn't appear to be affected by whether the hospitals were in states that required reporting of such infections or by other hospital characteristics, such as size, share of patients on Medicare or ownership, the study's authors wrote.
Grace Lee, the study's lead author, said the findings may reflect that the financial impact of the policy was limited, or that hospitals were already successfully engaged in efforts to reduce these infections. "It may not have been enough to motivate further change of behavior," said Dr. Lee, an associate professor at the Harvard Pilgrim Health Care Institute and Harvard Medical School. The study was funded by the federal Agency for Healthcare Research and Quality.
Previous research has shown mixed results for efforts to improve the quality of care by tweaking payments to hospitals, doctors and other providers. A research review of such programs for primary-care physicians concluded that there was "little rigorous evidence of their success in improving the quality of primary health care," or of their cost-effectiveness compared with other programs. The review was published last year by the Cochrane Collaboration, a nonprofit that specializes in reviewing medical literature.
"The jury is still out on whether or not it works, and under what circumstances it works," said Rachel Werner, associate professor of medicine at the University of Pennsylvania, who wasn't involved in the new study.
Still, there are growing efforts by government agencies and private insurers to tie payment to quality measures such as the rate of readmissions, which are deemed preventable. Among other changes, in 2015, Medicare will begin financially penalizing hospitals that have the highest rates of certain hospital-acquired health conditions.
The Centers for Medicare and Medicaid Services said, "Taken all together, our policies are working" to reduce infections patients get while in the hospital. The agency pointed to other efforts, including one program funded by the federal Agency for Healthcare Research and Quality that was tied to a 40% decrease in the rate of the catheter-linked bloodstream infections in hospital intensive-care units.
Nancy Foster, a vice president at the American Hospital Association, said the new study should make policy makers "take a step back and say, are payment penalties the right way to go, do they actually add to the efforts" on reducing infections and other hospital-acquired conditions?
Meredith Rosenthal, a professor of health economics at Harvard who wasn't involved in the new study, said the finding, while valuable, probably "doesn't have very strong implications" for the other Medicare pay-for-performance efforts, partly because of the relatively limited financial impact of the 2008 change, and the fact that the hospitals were already successfully focused on reducing the infections.
Write to Anna Wilde Mathews at anna.mathews@wsj.com
