Efforts to Reduce Surgical Site Infections May Penalize Higher-Quality Hospitals: Study

High-quality hospitals that offer more advanced services may be more likely to face penalties under new Medicare program that is designed to reduce surgical site infections. 

In a letter published earlier this month in the medical journal JAMA Surgery, researchers indicate that there may be unintended consequences from recent changes to the U.S. Centers for Medicare and Medicaid Services (CMS) Hospital Acquired Condition (HAC) Reduction Program, which is designed to provide financial penalties for poorly performing hospitals.

Researchers indicate that facilities at the bottom 25% of hospitals, which were the worst performing under the standards, were typically major teaching hospitals, with more quality accreditations and offering more advanced services.

Surgical site infections are “never events” by many experts, which can be avoided with implementation of procedures and precautions. However, the research letter identified a potentially contradictory relationship between hospital quality and penalties issued under the program designed to reduce hospital-acquired conditions.

Hospital-acquired infections have been a major focus throughout the medical community in recent years, with the CDC previously estimating that one in 25 patients will get a hospital-acquired surgical site infection, causing more than 700,000 in 2011. Other research has shown hospital-acquired infections may be relatively easy to reduce by implementing certain interventions, leading to reductions of as much as 77 percent.

The Hospital-Acquired Condition (HAC) Reduction program implemented by the CMS began to impose financial penalties for poorly performing hospitals beginning in federal fiscal year 2015.

Researchers took surgical site infection scores from the CMS Hospital Compare Data and merged it with fiscal year 2015 Medicare Impact File and 2014 America Hospital Association Annual Survey data. The study focused on any association between hospital characteristics, quality and programs, and surgical site infection measures. Research focused on surgical site infection outcome measures for colon surgery and abdominal hysterectomy through the HAC program for 2016.

Overall, the findings indicate higher-quality hospitals appear to be penalized significantly more in the HAC program than lower-quality hospitals.

An earlier study of the HAC program, published in 2015 in JAMA, also showed hospitals penalized more frequently were those that were major teaching hospitals and had better performance and outcome measures.

Weighing the findings of both studies, researchers say this may reveal surveillance bias, which is the notion that the more you look for something, the more you find data to support it.

They emphasize that simply because a hospital is a poor performer on CMS indicators, it does not truly reveal the hospitals quality of care. Hospitals that scored poorly on this measure were hospitals that offered high quality of care and advanced screening and treatment methods.

Researchers say a refinement of quality measures may need to be completed and should be an ongoing process. Ensuring infection surveillance and data abstraction standards are consistent across the nation is also important to ensure accurate results.

Research published in JAMA Internal Medicine revealed hospital-acquired infections may cost the U.S. nearly $10 billion each year. The estimate reveals the necessity of the new CMS infection reduction program, however the program may need refinements.

A 2013 study of hospital infections revealed one of the most expensive healthcare costs for the U.S. medical system include, severe sepsis infections acquired during a hospital stay. Hospital-acquired sepsis infections cost the nation more than $5 billion every year.