Preventing Avoidable Infectious Complications by Adjusting Payment (PAICAP)II

描述（由申请人提供）：在过去的十年中，我们看到了美国医疗保健文化的转变，更加注重质量、透明度和效率。随着付款人和患者越来越多地成为实现这些目标的声音利益相关者和合作伙伴，我们现在已经进入了一个加速变革的时期。卫生保健相关感染一直是这些努力的关键目标，特别是因为许多感染是可以预防的，并导致显著的发病率和卫生保健系统的成本。作为最大的国家付款人，CMS在调整质量和成本的运动中处于领先地位。2008年，CMS实施了经济处罚（即“棍棒”），作为通过医院获得性疾病（HAC）政策提高医疗保险患者质量的一种手段。这项政策停止了对艾滋病的额外支付，包括某些被认为是可以合理预防的医疗保健相关感染。在我们目前资助的R 01赠款中，我们正在评估2008年HAC政策对美国医疗相关感染率的影响。简而言之，我们发现HAC政策对NHSN的“真实”感染率没有影响;然而，我们确实证明了政策实施后不久某些HAI的“计费”率突然下降。CMS现在已经扩大了这些经济处罚，包括医疗补助患者，要求各州对医疗保健获得性条件（HCAC）实施相同的不付款政策，自2012年7月1日起生效。然而，对医疗相关感染的最大经济处罚将通过CMS医院基于价值的采购（VBP）计划实施，该计划旨在奖励和惩罚在一系列质量措施（包括NHSN数据）上表现最好和最差的医院，最高可达其整个基本运营预算的2%，这将是迄今为止最大的经济处罚之一。在这一竞争性更新中，我们试图评估这些经济处罚对健康结果的持续影响，这些影响是通过感染率和预期的NHSN监测率来衡量的。我们的具体目标是：1.评估医疗补助医疗获得性疾病（HCAC）政策对医疗保险、医疗补助和私人保险患者中医疗相关感染（HAI）“计费”率的影响。2.评价CMS基于价值的采购（VBP）计划对向国家医疗安全网络（NHSN）报告的HAI率的影响。3.使用账单与NHSN数据检查HAI的医院绩效排名差异，并探索与随时间推移的不一致排名相关的因素。4.探讨经济处罚对照顾高比例贫困或少数民族患者的医院HAI率的影响。

DESCRIPTION (provided by applicant): Over the past decade, we have seen a transformation in the culture of healthcare in the U.S., with a greater focus on quality, transparency and efficiency. As payers and patients have increasingly become vocal stakeholders and partners in achieving these goals, we have now entered an accelerated period of change. Healthcare-associated infections have been a key target of these efforts, particularly since many are potentially preventable and result in significant morbidity and costs to the healthcare system. As the largest national payer, CMS has led the way in the movement to align quality and cost. In 2008, CMS implemented financial penalties (i.e. "sticks") as a means for improving quality for Medicare patients through the hospital-acquired conditions (HAC) policy. This policy ceased additional payments for HACs, including certain healthcare- associated infections, which were deemed reasonably preventable. In our currently funded R01 grant, we are evaluating the impact of the 2008 HAC policy on rates of healthcare-associated infections in the U.S. In brief, we found the HAC policy had no impact on "true" infection rates in NHSN; however, we did demonstrate sudden declines in "billing" rates for certain HAIs shortly after policy implementation. CMS has now expanded these financial penalties to include Medicaid patients by requiring that states implement the same nonpayment policies for Health Care Acquired Conditions (HCAC) effective July 1, 2012. However, the greatest financial penalties for healthcare-associated infections will be implemented via the CMS Hospital Value Based Purchasing (VBP) program, which seeks to reward and penalize the highest and lowest performing hospitals on a range of quality measures, including NHSN data, by up to 2% of their entire base-operating budget, which will be among the largest financial penalties seen to date. In this competing renewal, we seek to assess the ongoing serial impact of these financial penalties on health outcomes, as measured by billing rates of infection and prospective NHSN surveillance rates. Our specific aims are: 1. To evaluate the impact of the Medicaid health care acquired conditions (HCAC) policy on "billing" rates for healthcare-associated infections (HAI) among Medicare, Medicaid and privately insured patients. 2. To evaluate the impact of the CMS Value-Based Purchasing (VBP) program on HAI rates reported to the National Healthcare Safety Network (NHSN). 3. To examine differences in hospital performance rankings for HAIs using billing vs. NHSN data and to explore factors associated with discordant rankings over time. 4. To explore the impact of financial penalties on HAI rates for hospitals that care for a high proportion of poor or minority patients.