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Government payment policies tied to hospital performance fail to improve patient safety

Implementation of these programs was not associated with reductions in device-associated CAUTI rates.

Jeff Lagasse, Associate Editor

Value-based incentive programs, or VBIPs, aim to drive improvements in quality and reduce costs by linking financial incentives or penalties to hospital performance.

But a new study has found no evidence these programs have any measurable association with changes in catheter-associated urinary tract infection rates in U.S. hospitals. It touts itself as the first study to look at how these federal payment programs impact healthcare-associated infections.


In 2013, the Centers for Medicare and Medicaid Services implemented VBIPs to financially reward or penalize hospitals based on quality metrics. These programs targeted hospitals' rates of certain healthcare-associated infections that were deemed preventable.

Previous studies demonstrated minimal impact of these payment programs on measures of hospital processes, patient experience and mortality. But their impact on patient safety metrics, including healthcare-associated infection rates, had been unknown.

Researchers at Boston University School of Medicine and the Harvard Pilgrim Health Care Institute examined changes in trends for different CAUTI-related quality measures in nearly 600 hospitals across the country. They found no evidence that the VBIPs had any measurable association with CAUTI rates in the critical care units of U.S. hospitals.

In particular, implementation of these programs was not associated with reductions in device-associated CAUTI rates, the measure that the programs explicitly target.

The good news for patients is that, while federal payment programs made little if any difference, there were modest improvements over time in the use of urinary catheters in hospitals' critical care units, along with a decreased risk for urinary tract infections in hospitalized patients.

According to the researchers, these results are relevant to public health because they provide crucial information on whether these federal payment programs should continue in their current form in the future.


Hospitals may have avoided financial penalties by billing hospital-associated conditions as present at the time of the patient's admission -- supporting prior work showing that a Medicare policy designed to monetarily penalize hospitals for preventable complications had an insignificant impact on reducing healthcare-associated infections, findings from June showed.

In addition, the targeted billing codes were rarely used by hospitals, far less than expected based on national estimates. And even when hospitals billed for HACs during a hospitalization, this infrequently affected the diagnosis-related group assignment, impacting hospital reimbursement.

Twitter: @JELagasse

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