Importance: In 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy denying incremental payment for 8 complications of hospital care, also known as never events. The regulation's effect on these events has not been well studied.
Objective: To measure the association between Medicare's nonpayment policy and 4 outcomes addressed by the HACs Initiative: central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure ulcers (HAPUs), and injurious inpatient falls.
Design, Setting, And Participants: Quasi-experimental study of adult nursing units from 1381 US hospitals participating in the National Database of Nursing Quality Indicators (NDNQI), a program of the American Nurses Association. The NDNQI data were combined with American Hospital Association, Medicare Cost Report, and local market data to examine adjusted outcomes. Multilevel models were used to evaluate the effect of Medicare's nonpayment policy on never events.
Exposures: United States hospitals providing treatment for Medicare patients were subject to the new payment policy beginning in October 2008.
Main Outcomes And Measures: Changes in unit-level rates of HAPUs, injurious falls, CLABSIs, and CAUTIs after initiation of the policy.
Results: Medicare's nonpayment policy was associated with an 11% reduction in the rate of change in CLABSIs (incidence rate ratio [IRR], 0.89; 95% CI, 0.83-0.95) and a 10% reduction in the rate of change in CAUTIs (IRR, 0.90; 95% CI, 0.85-0.95), but was not associated with a significant change in injurious falls (IRR, 0.99; 95% CI, 0.99-1.00) or HAPUs (odds ratio, 0.98; 95% CI, 0.96-1.01). Consideration of unit-, hospital-, and market-level factors did not significantly alter our findings.
Conclusions And Relevance: The HACs Initiative was associated with improvements in CLABSI and CAUTI trends, conditions for which there is strong evidence that better hospital processes yield better outcomes. However, the HACs Initiative was not associated with improvements in HAPU or injurious fall trends, conditions for which there is less evidence that changing hospital processes leads to significantly better outcomes.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508870 | PMC |
| http://dx.doi.org/10.1001/jamainternmed.2014.5486 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Public Views on Medicaid Work Requirements and Mandatory Premiums in Kentucky.
JAMA Health Forum
October 2023
Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia.
Article Synopsis
- Policymakers at both federal and state levels are pushing for work requirements and premiums in Medicaid, with the need to differentiate public opinion on these specific proposals.
- The study aimed to assess opinions of Kentucky adults on the proposed Medicaid work requirements and premiums through a survey conducted in mid-2019.
- Results showed a diverse participant demographic, highlighting significant portions of the population enrolled in Medicaid and differing political affiliations, indicating varied perspectives on Medicaid policy among residents.
Emergency Medical Treatment and Labor Act: Impact on Health Care, Nursing, Quality, and Safety.
Qual Manag Health Care
January 2024
Division of Emergency Medicine and Trauma Center (Dr Schultz), Accreditation, Licensure & Regulatory Affairs (Ms Forbes), and Environmental Safety & Emergency Management (Mss Forbes and Hafen Packard), Children's National Hospital, Washington, District of Columbia; and Division of Nursing, School of Medicine & Health Sciences, George Washington University, Washington, District of Columbia (Dr Schultz).
Nurse knowledge and expertise in Emergency Medical Treatment and Labor Act (EMTALA) are a prerequisite to meet emergency department practice laws and regulatory standards. EMTALA is a federal law that requires anyone coming to an emergency department for care to be stabilized and treated, regardless of their insurance status or ability to pay. Regulatory standard infractions resulting from an EMTALA violation complaint may include (1) penalties and/or fines, (2) future unannounced Centers for Medicare & Medicaid Services surveys, (3) documented Centers for Medicare & Medicaid Services deficiencies that require timely response, action plans, and audit for expected outcomes, (4) Medicare/Medicaid nonpayment for services, and (5) termination of a hospital's Medicare agreement.
View Article and Find Full Text PDFThis survey study compares the demographic characteristics, access to care, and health status of recent Medicaid enrollees in Wisconsin with and without experience of Medicaid lockouts.
View Article and Find Full Text PDFBilling and payment of commercial and Medicaid health plan adult vaccination claims in Michigan since the Affordable Care Act.
Vaccine
October 2019
University of Michigan, Ann Arbor, MI, United States. Electronic address:
Background: Provider concern regarding insurance non-payment for vaccines is a common barrier to provision of adult immunizations. We examined current adult vaccination billing and payment associated with two managed care populations to identify reasons for non-payment of immunization insurance claims.
Methods: We assessed administrative data from 2014 to 2015 from Blue Care Network of Michigan, a nonprofit health maintenance organization, and Blue Cross Complete of Michigan, a Medicaid managed care plan, to determine rates of and reasons for non-payment of adult vaccination claims across patient-care settings, insurance plans, and vaccine types.
Impact of Medicare's Nonpayment Program on Venous Thromboembolism Following Hip and Knee Replacements.
Health Serv Res
December 2018
Department of Public Health Sciences, University of Rochester, Rochester, NY.
Objective: To determine whether Medicare's Nonpayment Program was associated with decline in venous thromboembolism (VTE) following hip and knee replacements; and whether the decline was greater among hospitals at risk of larger financial losses from the Program.
Data Sources: State Inpatient Database for New York (NY) from 2005 to 2013.
Study Design: The primary outcome was an occurrence of VTE.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!