Another incentive, passed last year, requires state Medicaid programs to each formulate their own policies to deny payment for certain preventable adverse events such as healthcare-associated infections.
For further reductions of healthcare-associated infections, hospitals need greater incentives, such as expanded Medicare penalties, and adding to a list of adverse events won't be reimbursed by all payers including health plans, and a shift from fee-for-service to bundled payments, Zimlichman says.
"Obviously, as we slowly phase out of our fee-for-service approach, we're going to see hospitals investing much more in efforts to battle these complications, and there's no doubt about that. But again, if we're just showing the numbers, and there's no policy change, and no risk to the providers, it's doubtful how much difference this is going to make."
He adds that some progress is happening, although slowly. Some heath plans are adopting policies to refuse reimbursement for avoidable adverse events, such as preventable infections. "The game is starting to change," he says. "We know for example that 75% of infections are preventable," and special initiatives such as Michigan's keystone project have reduced CLABSI to zero.
In an accompanying editorial, journal editor Mitchell Katz, MD, wrote that healthcare administrators need motivation "to invest in the necessary systems to decrease these infections." Such costs might include information technology systems to minor rates following interventions, education of clinicians, time to continually reassess patients' need for catheters, lines, and ventilator support, and effectiveness of measures such as chlorhexidine baths.