But measured for each quarter from January, 2006 to March of 2011, the researchers found no change in the downward trajectory after the penalty took effect. They used a representative sample of 398 hospitals in 41 states.
"A lot of activities have resulted in these numbers going down," Jha says, including checklist recommendations from Johns Hopkins intensivist Peter Pronovost, MD. "We were trying to ask whether the 2008 policy impacted the rate of that change. We found pretty clear evidence that the policy did not have much of an impact."
The researchers postulated three reasons why hospitals didn't seem to respond to the penalty.
First, it may be an artifact from more accurate coding. Hospitals may have been more careful to reflect when a patient came into the hospital with an infection present on admission, which would not be penalized, if that was indeed the case, rather than acquiring it while in the hospital.
Second, they wrote, these two infections were already targeted as part of other improvement initiatives nationally, through quality improvement organizations, accreditation agencies and other efforts.
Third, the financial penalty has reportedly been relatively insignificant, "as little as .6% of Medicare revenue for the average hospital...Hospitals may not have made additional investments in prevention of infection."