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

Abstract

Objective In 2012, the Centers for Medicare and Medicaid Services expanded a 2008 program that eliminated additional Medicare payment for mediastinitis following coronary artery bypass graft (CABG) to include Medicaid. We aimed to evaluate the impact of this Medicaid program on mediastinitis rates reported by the National Healthcare Safety Network (NHSN) compared with rates of a condition not targeted by the program (deep space surgical site infection [SSI] after knee replacement). Design interrupted time series with comparison group. Methods We included surveillance data from non-federal acute care hospitals participating in NHSN and reporting CABG or knee replacement outcomes from 1/2009–6/2017. We examined the Medicaid program’s impact on NHSN-reported infection rates, adjusting for secular trends. Data analysis used generalized estimating equations with robust sandwich variance estimators. Results During the study period, 196 study hospitals reported 273,984 CABGs to NHSN, resulting in 970 mediastinitis cases (0.35%); 294 hospitals reported 555,395 knee replacements, with 1,751 resultant deep space SSIs (0.32%). There were no significant changes in incidence of either condition during the study. Mediastinitis models showed no effect of the 2012 Medicaid program on either secular trend during the post- vs. pre-program time periods (p-value=0.70) or immediate program effect (p-value=0.83). Results were similar in sensitivity analyses when adjusting for hospital characteristics, restricting to hospitals with consistent NHSN reporting, or incorporating a program implementation roll-in period. Knee replacement models also showed no program effect. Conclusions The 2012 Medicaid program to eliminate additional payments for mediastinitis following CABG had no impact on reported mediastinitis rates.

Do penalty-based pay-for-performance programs improve surgical care more effectively than other payment strategies? A systematic review

“…Ten studies examined outcomes of penalty based P4P programs on the quality of surgical care [ 13 , 15 , 23 ] [ [13] , [15] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] ] [ [13] , [15] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] ], with the majority showing that penalty designs were effective [ 24 , 26 , 27 , 29 , 30 ]. Although six out of 10 studies reported improved quality in surgical care, we conclude that one study did not congruently show a positive effect of P4P programs due to lack of comparison to the pre-policy period [ 23 ].…”

Costs versus earnings in colon surgery and coronary artery bypass grafting under a prospective payment system: Sufficient financial incentives to reduce surgical site infections?

“…In recent years, financial incentives to reduce healthcareassociated complications have gained momentum, resulting in manifold 'pay for performance' strategies; however, parts of such schemes may not be as effective as expected. 8 In our study, the prospective DRG payment system indirectly penalized hospitals for complications without having to rely on hard-to-collect performance indicators.…”

Assessment of Federal Value-Based Incentive Programs and In-Hospital Clostridioides difficile Infection Rates

“…Previously implemented CMS policies and the current VBIPs showed no evidence in reducing the rates of central catheter-associated bloodstream infections, surgical site infections after colon surgical procedures and abdominal hysterectomy procedures, 16 catheter-associated urinary tract infections, 17,18 and mediastinitis following coronary artery bypass graft surgery. 19,20 There are several possible explanations for the apparent association between VBIPs and the decline in HO-CDI rates. First, this could reflect a commitment by health care organizations in reducing the infection rates by taking increasingly aggressive measures to prevent CDI.…”