It has been about 14 months since a new directive from the Centers for Medicare and Medicaid Services (CMS) went into effect Oct. 1, 2008, essentially declaring that Medicare will no longer reimburse hospitals for extra costs related to certain infections acquired during a hospital stay: catheter-associated urinary tract infections (UTIs), catheter-associated bloodstream infections, mediastinitis, and some surgical site infections (SSIs) following certain orthopedic procedures.
According to Wright (2008) healthcare-acquired infections (HAIs) account for an estimated 1.7 million infections and 99,000 associated deaths each year; they affect 5 percent to 10 percent of hospitalized patients annually; and they add nearly $20 billion to healthcare costs each year.
The CMS ruling is part of an effort on the part of public and private agencies and organizations to address the lack of quality still evident in the U.S. healthcare system. Although the U.S. spends more per capita on healthcare than any other country in the world, U.S. healthcare system quality is often inferior to other nations and often does not meet evidence-based guidelines. In addition, the system is plagued by significant variations in quality and costs across the country.
In this ruling, CMS continues its quest to hitch payment to improved quality of care, something it undertook several years ago with its Quality Roadmap, comprised of five strategies to achieve higher quality of care for Medicare beneficiaries. One of these strategies is paying for healthcare services in a manner that reinforces CMS’s commitment to improving healthcare quality and outcomes, while avoiding unnecessary complications and costs. Straube (2006) says CMS acknowledges that strategies for quality improvement initiatives must involve promoting quality measurements as a foundation for supporting more effective quality improvement efforts, and that the agency must pay in a way that expresses its commitment to quality as well as helps providers and patients to take steps to improve health and avoid unnecessary costs. Straube (2006) also says that the federal system will rely on a number of factors to help it improve quality, including providing for greater transparency, supporting public reporting of quality and price information, promoting healthcare consumer informed choice, engaging in healthcare provider reimbursement and payment reform, and overall improved collaboration between public and private sectors.
Straube and Blum (2009) acknowledge that policies that decline payment in the event of hospital-acquired conditions have generated considerable public attention. They add that although the projected payment reductions are not large, small payment penalties have been effective in changing human behavior and ultimately in improving the hospital care experience for patients. They say that Medicare payment reductions for hospital-acquired conditions are only one component of several efforts to reduce their incidence; other CMS strategies to reduce hospital-acquired conditions include public reporting, quality improvement initiatives, value-based purchasing, quality metrics and guidelines development, and national coverage decisions.
