Perceived Impact of the Medicare Policy to Adjust Payment for Health Care-associated Infections




In 2008, the Centers for Medicare and Medicaid Services (CMS) ceased additional payment for hospitalizations resulting in complications deemed preventable, including several health care-associated infections. We sought to understand the impact of the CMS payment policy on infection prevention efforts.



A national survey of infection preventionists from a random sample of US hospitals was conducted in December 2010.



Eighty-one percent reported increased attention to HAIs targeted by the CMS policy, whereas one-third reported spending less time on nontargeted HAIs. Only 15% reported increased funding for infection control as a result of the CMS policy, whereas most reported stable (77%) funding. Respondents reported faster removal of urinary (71%) and central venous (50%) catheters as a result of the CMS policy, whereas routine urine and blood cultures on admission occurred infrequently (27% and 13%, respectively). Resource shifting (ie, less time spent on nontargeted HAIs) occurred more commonly in large hospitals (odds ratio, 2.3; 95% confidence interval: 1.0-5.1; P = .038) but less often in hospitals where front-line staff were receptive to changes in clinical processes (odds ratio, 0.5; 95% confidence interval: 0.3-0.8; P = .005).



Infection preventionists reported greater hospital attention to preventing targeted HAIs as a result of the CMS nonpayment policy. Whether the increased focus and greater engagement in HAI prevention practices has led to better patient outcomes is unclear.





Grace M. Lee MD, MPH – a,b*

Christine W. Hartmann PhD – c,d

Denise Graham BS – e
William Kassler MD, MPH – f

Maya Dutta Linn MPH – a

Sarah Krein PhD, RN – g

Sanjay Saint MD, MPH – g
Donald A. Goldmann MD – h

Scott Fridkin MD – i

Teresa Horan MPH – i

John Jernigan MD – i
Ashish Jha MD, MPH – j


*[email protected]


Author Affiliations


a – Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA

b – Department of Laboratory Medicine and Division of Infectious Diseases, Children’s Hospital Boston, Boston, MA
c – Center for Health Quality, Outcomes, and Economic Research, Bedford VA Medical Center, Bedford, MA

d – Department of Health Policy and Management, School of Public Health, Boston University, Boston, MA

e – Association for Professionals in Infection Control and Epidemiology, Washington, DC
f  – Centers for Medicare and Medicaid Services, New England Region, Boston, MA
g – Ann Arbor VA Medical Center and University of Michigan Medical School, Ann Arbor, MI
h – Institute for Healthcare Improvement, Cambridge, MA
i – Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA

j – Department of Health Policy and Management, Harvard School of Public Health, Boston, MA