Nonpayment for preventable infections in U.S. hospitals.
Nonpayment for preventable infections in U.S. hospitals.
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美国医院不支付可预防感染的费用。
DOI：
10.1056/nejmc1213732
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
Jha,AshishK
中科院分区：
文献类型：
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作者：
Lee,GraceM;Soumerai,StephenB;Jha,AshishK
致编辑：Lee等人(10月11日发布)1发现，医疗保险和医疗补助服务中心(CMS)对医疗保健获得性疾病不付款的处罚并未导致感染率显著降低。这一发现进一步证明，适用于以捆绑支付为主的支付系统的逐项处罚几乎不会导致质量变化。Medicare使用诊断相关组(DRG)支付系统，对于大多数DRG，如果存在“共病”或“重大共病”诊断，该系统允许增加报销。然而，即使在面临医疗保健获得性疾病的情况下，通过使用不同共存诊断的代码进行计费，仍然经常可以实现最大限度的补偿。在CMS实施不为卫生保健获得性疾病付费的政策实施后的第一年，全国医院只收回了1880万美元；其中只有85254美元是用于血管导管相关性感染的。2英联邦基金还报告说，这一倡议没有对安全网医院的护理做法产生重大改变。3对于基于价值的采购计划以提高质量，不仅必须使用有意义的指标，而且必须存在相当大的经济处罚和奖励。4.
To the Editor: Lee et al.(Oct. 11 issue) 1 found that the penalty imposed by the Centers for Medicare and Medicaid Services (CMS) of nonpayment for health care–acquired conditions did not result in a significant lowering of infection rates. This finding furthers the evidence that line-item penalties applied to a predominantly bundled payment system result in little change in quality. Medicare uses a diagnosis-related group (DRG) payment system, which for most DRGs allows an increase in reimbursement if a “comorbidity” or “major comorbidity” diagnosis exists. However, maximum reimbursement can still often be achieved even in the face of a health care–acquired condition by billing with the use of codes for a different coexisting diagnosis. During the first year after implementation of the CMS policy of nonpayment for health care–acquired conditions, only $18.8 million was recouped from hospitals nationwide; of this amount, only $85,254 was for vascular catheter-associated infections. 2 The Commonwealth Fund has also reported that this initiative did not produce a major change in care practices in safety-net hospitals. 3 For valuebased purchasing initiatives to improve quality, not only must meaningful metrics be used, but also considerable financial penalties and rewards must exist. 4