Hospital-acquired Infection Reductions

Sometimes you wonder if policymakers will ever recognize their failures and the limitations of trying to dictate changes in outcomes by government fiat.  The Medicare program during the last administration attempted a whole series of these programs, none of which has come close to accomplishing its supposed aims.  We discussed the hospital readmissions program earlier this week.  Another such program was the attempt to reduce hospital-acquired infections and other conditions by penalizing hospitals that had too many.  A study reported in Health Affairs suggests that this program also did not meet its goals.   (HA Article)   Originally CMS was just refusing to pay the additional costs of treatment for conditions acquired during the course of a hospitalization but in 2013 it added specific substantial penalties to hospitals in the top quartile of HAC rates.  The program has been dogged from the start by data collection and accuracy issues, which complicate evaluations of its effectiveness.  As usual in this kind of analysis, untangling what the results of the program were from other underlying trends and factors is difficult.  The authors used detailed data from Michigan which included detailed information on over 90% of the inpatient surgery procedures in the state from 2010 to 2018.  The Medicare program targeted central line associated bloodstream infections and catheter-associated urinary tract infections, as well as surgical site infections related to colon surgery and hysterectomy.  The researchers examined whether trends in reductions of these conditions was different from that of trends relating to conditions not covered by the Medicare penalty program.

The statistical analyses included a variety of usual adjustments for patient factors and hospital characteristics.  Overall the rate of hospital-acquired conditions was 133.4 per 1000 discharges before the CMS reduction program and 122.2 after the program was in effect.  The rate declined at about 6.2 events per year per 1000 discharges in each year after initiation of the penalties.  For the conditions targeted by the CMS reduction program, there were 61.7 events per 1000 discharges before the penalties started and in the post period there were 58.7.  There was no significant change in the trendline related to targeted conditions before and after initiation of the penalties.  Ooops, didn’t make a difference.  Also known as hammering hospitals for no good reason.  Non-targeted conditions had pre and post program rates of 71.6 and 63.5, and while the change wasn’t statistically significant, for whatever reason, non-targeted conditions actually showed a bigger reduction trend than did targeted ones.  The authors’ overall conclusion was that the program actually was associated with an increase in hospital-acquired conditions of 5 per 1000 discharges.  So another government effort, however well-intentioned, that reduced revenue to hospitals, imposed administrative costs, may have had unintended behavioral consequences and did nothing to accomplish its stated goal–reducing hospital acquired health conditions.  So when are policymakers going to learn the limits of their abilities and develop a little hubris.