Hospital-Acquired Infections Under Pay-for-Performance Systems: an Administrative Perspective on Management and Change
Purpose of Review
The purpose of this review is to explore the impact of hospital-acquired infection on payment under pay-for-performance systems, and provide perspective on the role of administrators in infection prevention.
Hospital-acquired infections continue to pose a serious threat to patient safety and to the fiscal viability of healthcare facilities under pay-for-performance systems. There is mixed evidence that use of pay-for-performance systems leads to prevention of hospital-acquired conditions. Use of evidence-based guidelines has been shown to reduce hospital-acquired infections.
Increasing use of pay-for-performance (PFP) systems results in potential loss of reimbursement for healthcare organizations that fail to prevent hospital-acquired infections (HAI). Healthcare administrators must work with front-line providers and infection control staff to establish and maintain evidence-based infection prevention policy. Additionally, infection control policy should be regularly updated to reflect best practices, and proper change management techniques should be employed in order to mobilize and empower staff to increase their ability to prevent hospital-acquired infections.
KeywordsHospital-acquired infection Change management Pay for performance Healthcare administration Healthcare management Alternative payment models Hospital-acquired condition CMS Medicare reimbursement Medicaid reimbursement Hospital reimbursement Nosocomial condition CLABSI Kotter method Kotter change management Preventing hospital infection Infection prevention Hospital management Organizational change CMS payment Infection prevention program Horizontal vs vertical intervention Horizontal infection control Vertical infection control
The authors would like to thank Michele Fleming, MSN, RN, CIC, for her review of this manuscript.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.• Kotter JP. Leading change. Harvard Business Press; 1996. Kotter’s eight-step model is used to manage change across a wide variety of organizations and industries. The eight steps of change occur in three phases: (a) establishing optimal conditions for change; (b) enabling the organization for change and empowering individuals for change; and (c) implementing and sustaining change. In Table 1, an example plan is given using the Kotter model. Google Scholar
- 2.•• Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, et al. Health care–associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013;173(22):2039–46. Zimlichman and his colleagues provide an estimation of healthcare costs attributed to hospital-acquired infections in the USA using data from years 1986 through 2013. Major findings include (a) central line-associated bloodstream infections are the most expensive per-case hospital-acquired infections; (b) the total annual cost for the five major infections is approximately $9.8 billion; and (c) surgical site infections contribute the most to total hospital-acquired infection treatment cost at 33.7%. CrossRefPubMedGoogle Scholar
- 3.• Scott RD. The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention. Commissioned by the Centers for Disease Control and Prevention in 2009, Economist R. Douglas Scott reports on the economic impact of treating and preventing hospital-acquired infections in the USA. The overall annual direct medical costs of hospital-acquired infection treatment was estimated at $28.4 to $33.8 billion (using consumer price index for all urban consumers) and $35.7 billion to $45 billion (using consumer price index for inpatient hospital services). The benefits of hospital-acquired infection prevention are estimated at a low to be $5.7 to $6.8 billion (20% of infections preventable, consumer price index for all urban consumers) and at a high to be $25.0 to $31.5 billion (70% of infections preventable, consumer price index for inpatient hospital services). Google Scholar
- 5.Centers for Medicare & Medicaid Services. Hospital-Acquired Condition Reduction Program (HACRP).Google Scholar
- 7.• Waters TM, Daniels MJ, Bazzoli GJ, Perencevich E, Dunton N, Staggs VS, et al. Effect of Medicare’s nonpayment for hospital-acquired conditions: lessons for future policy. JAMA Intern Med. 2015;175(3):347–54. This reference outlines effects of Medicare’s financial penalties for hospital-acquired conditions. For conditions with strong evidence-based guidelines available (including central line-associated bloodstream infections and catheter-associated urinary tract infections) nonpayment is associated with improving trends. CrossRefPubMedPubMedCentralGoogle Scholar
- 14.•• Yokoe DS, Anderson DJ, Berenholtz SM, Calfee DP, Dubberke ER, Ellingson KD, et al. A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Am J Infect Control. 2014;42(8):820–8. This reference includes a comprehensive set of evidence-based guidelines for prevention and management of hospital-acquired infections in acute healthcare settings. The guidelines are a result of collaboration between experts led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission. CrossRefPubMedGoogle Scholar
- 17.Timsit JF, Schwebel C, Bouadma L, Geffroy A, Garrouste-Orgeas M, Pease S, et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA. 2009;301(12):1231–41.CrossRefPubMedGoogle Scholar
- 20.Lam TB, Omar MI, Fisher E, Gillies K, MacLennan S. Types of indwelling urethral catheters for short-term catheterisation in hospitalised adults. Cochrane Libr. 2014.Google Scholar
- 28.Health Information Technology Research Center (HITRC), healthit.govGoogle Scholar