Medicare Policy Might Discourage Proper Care for Hospital-Acquired Infections

Medicare’s recent policy of refusing to pay hospitals’ additional costs to treat hospital-acquired infections fails to adequately incentivize prevention and proper treatment of these complications, associated with 99,000 deaths annually. A recent analysis by Peter McNair and colleagues in the journal Health Affairs suggests that, in the entire state of California, only 11 hospitalizations complicated by infection would have received lower reimbursement as a result of the policy if it had been in place in 2006.The Medicare policy focuses on infections that have low mortality, such as catheter-associated urinary tract infections, and infections that affect few people, such as mediastinitis after CABG surgery. This means that the vast majority of severe hospital-acquired infections remain completely unregulated.

It is even more problematic that Medicare relies on existing hospital billing systems to identify infections and determine when additional reimbursement should be denied. These billing systems were not designed to accurately track hospital infections. Further, patients with infections often have other complications that earn the same level of reimbursement from Medicare. This effect is that Medicare will fail to identify most of the infections it aims to find and that, when cases of hospital infection are identified, these cases will rarely see any change in reimbursement.The recent Medicare policy may even perversely discourage hospitals from treating infections properly once they arise. Serious complications of infections that are responsible for high mortality, such as sepsis, are not considered under the policy. This means that while relatively minor infections may not be reimbursed, if these infections become serious, hospitals likely will be reimbursed for the additional costs of treating the more severe complications.This is hardly proper incentive for hospitals to prevent infections when they can be prevented and properly treat them when they do occur. An empty willingness to regulate is unlikely to reduce the high number of deaths that occur from hospital infections each year and lower the economic burden of these infections on the healthcare system.Medicare officials Barry Straub and Jonathan Blum have stressed that this policy is part of a broader program to improve health quality and that other insurers often base their reimbursement policies on Medicare policy, broadening the impact. Unfortunately, the impact is so low that including peripheral effects is unlikely to make much difference. The Medicare officials argue that a program that has a small financial impact may induce behavioral changes on a larger scale. There is no evidence that hospitals will react to the Medicare nonreimbursement policy out of proportion to the financial impact of this policy on their operations.

Maya Sequeira is a research assistant at Resources for the Future, an independent Washington, D.C. think tank whose Extending the Cure project provides policy solutions for the growing threat posed by antibiotic resistance.

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thomas perrazRickPookieMDPharma Heidi Recent comment authors
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thomas perraz
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the hospitals must be keep healthy by maintaining the clean and clear environment, if the infections are increases then it may affect the health of all people in there

thomas perraz
Guest

the hospitals must be keep healthy by maintaining the clean and clear environment, if the infections are increases then it may affect the health of all people in there

thomas perraz
Guest

the hospitals must be keep healthy by maintaining the clean and clear environment, if the infections are increases then it may affect the health of all people in there

thomas perraz
Guest

the hospitals must be keep healthy by maintaining the clean and clear environment, if the infections are increases then it may affect the health of all people in there

Rick
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Rick

In my view, the real problem of non-reimbursement for treatment of hospital-acquired infections is that it won’t really penalize the hospitals. After all, if a patient has to get treated for catheter-induced UTI, or sepsis, or whatever from the Medicare or Leapfrog lists, the staff still gets paid and the heat and light bills still come, so to speak. A hospital would likely respond to not getting reimbursed for these “come-back” treatment costs by spreading those costs around among the other paying customers. I understand that this could make the hospital price-uncompetitive with other nearby hospitals, but this wouldn’t matter… Read more »

PookieMD
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I too have issues with the medicare “no pay” list, but have a different perspective. You mention that “medicare…may discourage hospitals from treating infections…” My caveat is this: physicians treat infections, not hospitals. Physicians are NOT disincentivized to treat, and moreover are morally obligated to prevent and treat infections, no matter what Medicare or Medicaid does. I think the “no pay” path is misguided, but am glad more awareness is being paid to UTIs, pressure ulcers,and falls however.

Pharma Heidi
Guest

I do not understand why if and when medicare becomes a true reality, insurance providers would base their coverage on it still. Then it becomes a useless service more or less I would think. In Canada insurance is to cover things beyond the scope of medicare and non ‘necessity’ procedures. Either way it is still an abomination that ALL hospital related illnesses would not be covered under the new system. Why wouldn’t medicare at least clean up the messes that it creates!