Becker's Clinical Quality & Infection Control

31 QUALITY IMPROVEMENT & MEASUREMENT CMS eases readmission penalties for safety-net hospitals By Alia Paavola P artially because of a push from Con- gress, CMS is easing its penalties for 30-day readmissions for hundreds of safety-net hospitals, according to NPR. The penalties were established in 2012 under the ACA in an effort to boost patient care. CMS estimates hospitals will lose $566 million in the latest round of penalties that will be assessed over the next 12 months because patients ended up back in their facilities. Safety-net hospitals, which serve a large number of low-income patients, have ar- gued for years that these sanctions adverse- ly affect them. ey have argued that their patients are more likely to suffer complica- tions and have a readmission through no fault of the institution, but rather because the patients can't afford necessary medica- tions or don't have primary care physicians to monitor their recovery. Effective Oct. 1, lawmakers mandated that CMS consider the long-standing argu- ment from safety-net hospitals: that they shouldn't be penalized or held to the same standard of readmission as other hospitals. In a major change to its evaluation of read- mission rates that took effect this year, CMS stopped judging each hospital's readmission performance against all other hospitals. Rath- er, the agency assigned hospitals to one of five peer groups with similar percentages of low-income patients. To assess the penalties, Medicare compared each hospital's readmis- sion rates from July 2014 to June 2017 against the readmission rates of its peers to deter- mine whether a penalty should be assessed and how much the penalty would be. CMS will assess penalties or dock payments to 2,599 hospitals in fiscal year 2019, which begins Oct. 1. e penalties resulted from fiscal year 2018 readmissions. However, the new evaluation method has shied the burden of those punishments away from safety-net hospitals. Penalties levied against safety-net hospitals in fiscal year 2019 will drop by a fourth on average from fiscal year 2018, according to NPR. "It's pretty clear they were really penalizing those institutions more than they need- ed to," Atul Grover, MD, executive vice president of the Association of American Medical Colleges, told NPR. "It's definitely a step in the right direction." n Septic shock mortality rates improved since 'surviving sepsis' guidelines released By Megan Knowles O verall mortality rates in septic shock improved in the 10 years after the Surviving Sepsis Campaign guidelines were introduced in 2004, a study published in CHEST found. The campaign focused on improving outcomes in patients with sepsis and septic shock. The 10-year study used the 2004 to 2014 Nationwide Inpatient Sample databases and included patients with a primary diagnosis of septic shock at dis- charge. The researchers looked at patient outcomes such as overall in-hospital mortality and percentage of patients discharged home. The study found in-hospital mortality decreased from 51.7 percent to 39.3 percent from 2004 to 2014. The researchers found no significant differences in how often patients were discharged home or differences in how often patients were discharged to long-term care facilities when comparing the two time periods. "The overall mortality in septic shock improved in the decade following the introduction of the [campaign] guidelines," the researchers concluded. n HAIs can be cut up to 55% through infection control interventions, study finds By Megan Knowles C are facilities can cut healthcare-associated infections by up to 55 percent through evidence-based infection control interventions, regardless of a country's econom- ic status, a review of 144 studies published in Infection Control & Hospital Epidemiology found. The researchers reviewed 144 studies published around the world, including 56 conducted in the U.S., between 2005 and 2016 to find the proportion of HAIs prevented through infec- tion control interventions in different economic settings. Each study in the review looked at efforts designed to prevent at least one of the five most common HAIs using a combi- nation of two or more interventions, such as education and surveillance or preoperative skin decolonization and preoper- ative changes in skin disinfection protocol. Interventions consistently led to a 35 percent to 55 per- cent reduction in new infections, the researchers found. The largest effect was in preventing central line-associated bloodstream infections. "Our analysis shows that even in high-income countries and in institutions that supposedly have implemented the standard- of-care infection prevention and control measures, improve- ments may still be possible," said lead study author Peter Schreiber, MD. n

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