One of the quality programs promulgated by CMS over the last few years was designed to reduce hospital-acquired conditions, such as infections. There were eight of these “never” events, including several infections, falls, and pressure ulcers. An article in the Journal of the American Medical Association reviews the impact of CMS’ nonpayment policy on the rates of four of these events. (JAMA Internal Medicine Article) The research covered data from about 1380 hospitals from July 2006 to the end of 2010. The primary outcome was a change in the rates of the events from before enactment of the policy to after. Over the study period rates of hospital-acquired pressure ulcers and inpatient falls declined modestly, but the rate of change did not accelerate after CMS declared these to be never events, suggesting that the initiative did not affect how often patients developed one of these conditions. For central-line bloodstream infections and catheter-associated urinary tract infections, the rates had been rising slightly at the start of the study period, but over the last 27 months showed a significant decline, at least 10%. The difference in impact may be due to the fact that for infection prevention there were well-developed guidelines, whereas there was less evidence on best practices for prevention of falls or pressure ulcers. It may be that these latter conditions are not as preventable, putting hospitals in a difficult position if they wish to avoid penalties. It appears, however, that the initiative is having success to some extent in improving quality of care.
