CMS changes: Glass half-full, but of what?

January 12th, 2015

The Centers for Medicare and Medicaid Services controversial 2008 policy to cut reimbursement for certain health care associated infections (HAIs) has led to positive clincial consequences -- and some unintended ones.

Overall, the first research assessment of the impact of the CMS policy finds the glass more full than empty. For example, many infection preventionists report that catheters are being removed in a more timely manner since the CMS no longer pays for the additional costs of catheter-related urinary tract infections and other "preventable conditions" (catheter-related vascular infections, infectious complications of mediastinitis.)

This direct clinical consequence to a fiscal policy is very encouraging, but infection preventionists are also struggling with the unintended consequences of the CMS policy. As surveillance of such infections is subjected to analysis and parsing, many IPs find themselves in situations akin to a baseball umpire making an extremely close call.

“We heard this a lot in the qualitative work [that included interviewing IPs],” said Grace Lee, MD, MPH, associate medical director of infection control at Children's Hospital in Boston. “Some people said the pressure was really on the billing staff and the hospital as a whole to try and modify their coding practices to ‘game’ the best reimbursement possible. In other hospitals, I was actually surprised, the IPs were at the frontline trying to coordinate between the physicians and the coders and get this to all work out. Which actually is a huge `time sink’ when you think about it, taking you away from all of the other activities that you want to do.”

Lee and colleagues conducted a survey and accompanying research to assess the impact of the CMS policy on IPs and infection prevention resources. Preliminary findings from the unpublished study were presented recently in Baltimore at the annual conference of the Association for Professionals in Infection Control and Epidemiology.

For more on this important story see the September issue of Hospital infection Control & prevention.