Several years ago, Medicare came up with an idea that seemed like a no-brainer: Stop paying hospitals to treat infections that patients pick up while they are in the hospital. That, the agency hoped, would both save money and cut back on preventable infections. Unfortunately, a new study suggests that effort has not yet translated into fewer hospital-acquired infections, or saved much money.
The study, published this week in the New England Journal of Medicine, focused on two common infections: bloodstream infections from contaminated central-line catheters, and urinary tract infections associated with urinary catheters.
Researchers analyzed data from 398 hospitals in 41 states. There were significant decreases in infection rates right before and right after the policy was implemented, in October 2008. But since then, the policy seems to have had no effect, good or bad.
One possible reason for the non-effect of the non-payment policy? The researchers speculate that some hospitals may have simply changed the way they report the problems, saying that people arrived at the hospital with the infections rather than picking them up when they were patients.
Also, the financial disincentive may just not be big enough to matter, so hospitals haven't bothered to make additional investments in practices that would lower infection rates. "The cumulative estimated savings was $20 million a year," says Lisa McGiffert, head of Consumers Union's Safe Patient Project. "That's small potatoes for Medicare," she says.
While this study found financial disincentives did not reduce hospital-acquired infections, it has some limitations: these hospitals may not be representative of all U.S. hospitals; the researchers did not include information on privately insured patients; and the CMS policy may have raised awareness of hospital-acquired infections in other, non-measured ways, such as greater awareness of infection rates.
For more on hospital infections and steps you can take to protect yourself, see our full hospital Ratings (available to subscribers) . And read our report How Safe Is Your Hospital?
Effect of Nonpayment for Preventable Infections in U.S. Hospitals [New England Journal of Medicine]