Dr. Teresa Waters, Chair of the UTHSC Department of Preventive Medicine, Leads Study Finding Medicare Penalties Improve Results for Some Hospital-Acquired Conditions

|
Dr.  Teresa Waters
Dr. Teresa Waters

Medicare penalties implemented in 2008 have made a difference in reducing certain hospital-acquired complications, according to a paper authored by Teresa M. Waters, PhD, chair of the Department of Preventive Medicine in the College of Medicine at the University of Tennessee Health Science Center (UTHSC). The paper was published in JAMA Internal Medicine, an international peer-reviewed journal for practitioners in general internal medicine and related subspecialties.

The paper titled, “Effect of Medicare’s Nonpayment for Hospital-Acquired Conditions: Lessons for Future Policy,” examined Medicare’s Hospital-Acquired Conditions Initiative, which denies payment for eight complications of hospital care known as “never events.” The penalties are an effort to reduce the occurrence of these complications.

Specifically, Dr. Waters and her co-authors looked at four of the conditions: central line-associated bloodstream infections, catheter-associated urinary tract infections, hospital-acquired pressure ulcers, and injurious inpatient falls.

Using data from the National Database of Nursing Quality Indicators, the American Hospital Association’s Medicare Cost Report, and local market data, the study looked at adult nursing units in 1,381 hospitals in the United States.

The researchers found the initiative was associated with reduced infections: an 11 percent reduction in the rate of change in central line-associated bloodstream infections and a 10 percent reduction in the rate of change in catheter-associated urinary tract infections.  It did not significantly change the number of injurious falls or pressure ulcers.

The authors hypothesize that penalties may result in improvements for conditions with standardized protocols to achieve better outcomes. Evidence-based prevention protocols for hospital infections were well developed before penalties were implemented in 2008. For events like falls, where there are few widely adopted interventions that have been demonstrated to improve outcomes, it is more difficult to affect change.

“Our results provide important insights for new policies related to hospital-acquired conditions. When a strong evidence base and standardization are absent, it may be important to first invest directly in science, rather than rely on incentives to drive scientific development,” Dr. Waters said. “As Medicare moves away from traditional fee-for-service toward alternative payment models that emphasize value-based purchasing, it is critical to study what actually works to increase value, or quality and outcomes.”

To read the paper, visit http://archinte.jamanetwork.com/article.aspx?articleid=2087876