Wednesday, July 25, 2012

Did the CMS no-payment rule impact hospital HAI prevention practice?

Beginning in October 2008 CMS stopped reimbursing hospitals for excess costs attributable to CLABSI or CAUTI.  While numerous studies and surveys have linked high compliance with HAI prevention bundles for CLABSI and VAP to reduced infection rates, few studies have looked at whether CMS no payment rules improved HAI prevention process measures.

To answer that question, Sarah Krein at the VA Ann Arbor Healthcare System completed surveys of VA and non-VA hospital HAI prevention practices in 2005 and again in 2009.  Their hypothesis was that if adoption of HAI bundles differed between non-VA and VA facilities, some of this difference could be do to the CMS no payment rules since VA facilities aren't directly affected by CMS rules.

The results are pretty interesting and don't really support any impact from the CMS no payment rules.  For CLABSI, both VA and non-VA hospitals reported significant increases in bundle component use with VA having higher use in both 2005 and 2009 (see graph below).

Similar results were reported for VAP and CAUTI.  The authors conclude by saying that "the CMS payment rule is likely not the primary driver of the increased use of infection prevention practices among US hospitals over the past several years."

Source: Krein et al. JGIM July 2012


  1. Unconvincing because VA hospitals were undergoing an independent mandate at the time.

  2. Don, can you explain how the VA mandate would impact the reported findings? I am not convinced that the MRSA mandate in VA would impact four unrelated process measures for CLABSI and CAUTI. It also seems that there were a lot of other mandates (Illinois, Pennsylvania) that could impact the findings in a similar way, but not sure if this changes Krein's findings or conclusions.