CMS Changes in Reimbursement for HAIs

BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) promulgated regulations commencing October 1, 2008, which deny payment for selected conditions occurring during the hospital stay and are not present on admission. Three of the 10 hospital-acquired conditions covered by the new CMS policy involve healthcare-associated infections, which are a common, expensive, and often preventable cause of inpatient morbidity and mortality. OBJECTIVE: To outline a research agenda on the impact of CMS's payment policy on the healthcare system and the prevention of healthcare-associated infections. METHODS: An invitational day-long conference was convened in April 2009. Including the planning committee and speakers there were 41 conference participants who were national experts and senior researchers. RESULTS: Building upon a behavioral model and organizational theory and management research a conceptual framework was applied to organize the wide range of issues that arose. A broad array of research topics was identified. Thirty-two research agenda items were organized in the areas of incentives, environmental factors, organizational factors, clinical outcomes, staff outcomes, and financial outcomes. Methodological challenges are also discussed. CONCLUSIONS: This policy is a first significant step to move output-based inpatient funding to outcome-based funding, and this agenda is applicable to all hospital-acquired conditions. Studies beginning soon will have the best hope of capturing data for the years preceding the policy change, a key element in non-experimental research. The CMS payment policy offers an excellent opportunity to understand and influence the use of financial incentives for improving patient safety

Business · Economic growth · Economics · Family medicine · Health care · MEDLINE · Political science · Reimbursement · Emergency and Acute Care Studies · Infection Control in Healthcare · Medicine · Nosocomial Infections in ICU

• Are Evidence-based Practices Associated With Effective Prevention of Hospital-acquired Pressure Ulcers in US Academic Medical Centers

  William V Padula, Robert D Gibbons et al.•Medical Care•2016

  Añadir item

• Impact of Medicare’s Nonpayment Program on Hospital-acquired Conditions

  Caroline P Thirukumaran, Laurent G Glance et al.•Medical Care•2017

  Añadir item

• Revisiting the Behavioral Model and Access to Medical Care

  Ronald Andersen, Ronald M Andersen•Journal of Health and Social…•1995

  Añadir item