Effect of Medicare’s Nonpayment Policy on Surgical Site Infections Following Orthopedic Procedures

Abstract

OBJECTIVE Orthopedic procedures are an important focus in efforts to reduce surgical site infections (SSIs). In 2008, the Centers for Medicare and Medicaid (CMS) stopped reimbursements for additional charges associated with serious hospital-acquired conditions, including SSI following certain orthopedic procedures. We aimed to evaluate the CMS policy's effect on rates of targeted orthopedic SSIs among the Medicare population. DESIGN We examined SSI rates following orthopedic procedures among the Medicare population before and after policy implementation compared to a similarly aged control group. Using the Nationwide Inpatient Sample database for 2000-2013, we estimated rate ratios (RRs) of orthopedic SSIs among Medicare and non-Medicare patients using a difference-in-differences approach. RESULTS Following policy implementation, SSIs significantly decreased among both the Medicare and non-Medicare populations (RR, 0.7; 95% confidence interval [CI], 0.6-0.8) and RR, 0.8l; 95% CI, 0.7-0.9), respectively. However, the estimated decrease among the Medicare population was not significantly greater than the decrease among the control population (RR, 0.9; 95% CI, 0.8-1.1). CONCLUSIONS While SSI rates decreased significantly following the implementation of the CMS nonpayment policy, this trend was not associated with policy intervention but rather larger secular trends that likely contributed to decreasing SSI rates over time. Infect Control Hosp Epidemiol 2017;38:817-822.

The Impact of the Medicaid Healthcare-Associated Condition Program on Mediastinitis Following Coronary Artery Bypass Graft

“…11,13,28 For mediastinitis following CABG, there are a number of possible explanations for why the HAC POA programs did not lead to demonstrable decreases in reported rates of this complication. First, both the Medicare and Medicaid HAC POA programs targeted mediastinitis for non-reimbursement during the index surgical admission for CABG.…”

“…While elimination of additional payment for preventable complications occurring during hospitalization may improve the value of inpatient care by reducing unnecessary spending, the Medicare and Medicaid HAC POA programs have failed to demonstrate any direct influence on reductions in preventable harm 11 13 , 28 For mediastinitis following CABG, there are a number of possible explanations for why the HAC POA programs did not lead to demonstrable decreases in reported rates of this complication. First, both the Medicare and Medicaid HAC POA programs targeted mediastinitis for nonreimbursement during the index surgical admission for CABG.…”

Effectiveness of national and subnational interventions for prevention and control of health-care-associated infections in acute hospitals in high-income and upper-middle-income counties: a systematic review update

“…Most were conducted in USA (n=25). [12][13][14]17,19,20,[22][23][24][25][26][27][29][30][31][34][35][36][37]39,40,42,[44][45][46] The remaining studies derived from England (n=2), 11,33 Taiwan (n=2), 16,21 Australia (n=1), 28 Brazil (n=1), 15 Germany (n=1), 18 Israel (n=1), 38 Italy (n=1), 43 New Zealand (n=1), 32 and Republic of Ireland (n=1). 41 Study designs included 21 ITS, 12,14,[17][18][19][20][21]24,[29][30][31][32][33][34]…”

“…11,36 Interventions were categorised according to the type of intervention, including care bundles, 16,39 care bundles with implementation strategies, [11][12][13]18,21,26,31,43,46 IPC programmes 14,15,17,20,[28][29][30][32][33][34][35][36]38,[40][41][42] and regulations. 19,[22][23][24][25]27,37,44,45 Study outcomes are presented in Error! Reference source not found.…”

Evaluation of Clinical and Economic Outcomes Following Implementation of a Medicare Pay-for-Performance Program for Surgical Procedures

“…Although it has been more than 10 years since the HAC-POA program was implemented, little is known about whether the program is associated with improved surgical care outcomes. Three studies have examined surgical outcomes associated with the HAC-POA program, but issues with study design, such as the absence of a comparison with the prepolicy period, a control group subject to spillover effects, and a short study period, have limited the evaluation of the HAC-POA program.…”