Does pay for performance in HAI pay off?
The data is piling up suggesting that the CMS policy for nonpayment for HAIs have had little impact on reducing preventable HAIs in acute-care settings. The straw that might break the camel's back is a study in this week's NEJM by Grace Lee and colleagues. Using a quasi-experimental design and time-series analysis, this AHRQ-funded study looked to see if there was a change in HAI rates after (vs before) the October 2008 nonpayment policy went into effect. 398 NHSN hospital provided data. The results are pretty conclusive: there were no changes in CLABSI, CAUTI or VAP after the implementation of the policy. In the figures below you can see that things are getting better, just not due to nonpayment.
Of course this is not surprising. Peter McNair published a very nice study in Health Affairs (2009) that estimated that the total financial impact across the entire US would be about $1.1 million annually for six avoidable conditions. When you divide that amount by the number of US hospitals you get...about nothing per hospital. I think CMS might need a bigger stick.
Source: Lee GM et al. NEJM 2012; 367: 1428-37
Of course this is not surprising. Peter McNair published a very nice study in Health Affairs (2009) that estimated that the total financial impact across the entire US would be about $1.1 million annually for six avoidable conditions. When you divide that amount by the number of US hospitals you get...about nothing per hospital. I think CMS might need a bigger stick.
Source: Lee GM et al. NEJM 2012; 367: 1428-37
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