Adverse Effects of the Medicare PSI-90 Hospital Penalty System on Revenue-Neutral Hospital-Acquired Conditions.

Padula, WV; Black, JM; Davidson, PM; Kang, SY; Pronovost, PJ

Adverse Effects of the Medicare PSI-90 Hospital Penalty System on Revenue-Neutral Hospital-Acquired Conditions.

Padula, WV Black, JM Davidson, PM Kang, SY Pronovost, PJ

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Publisher:: LIPPINCOTT WILLIAMS & WILKINS
Publication Type:: Journal Article
Citation:: Journal of patient safety, 2020, 16, (2), pp. e97-e102
Issue Date:: 2020-06

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Field	Value	Language
dc.contributor.author	Padula, WV
dc.contributor.author	Black, JM
dc.contributor.author	Davidson, PM
dc.contributor.author	Kang, SY
dc.contributor.author	Pronovost, PJ
dc.date.accessioned	2020-10-01T23:26:35Z
dc.date.available	2020-10-01T23:26:35Z
dc.date.issued	2020-06
dc.identifier.citation	Journal of patient safety, 2020, 16, (2), pp. e97-e102
dc.identifier.issn	1549-8417
dc.identifier.issn	1549-8425
dc.identifier.uri	http://hdl.handle.net/10453/142988
dc.description.abstract	OBJECTIVE:Health systems are grappling with improving the quality and safety of health care. By setting clear expectations, there is an opportunity to configure care models to decrease the risk of adverse events and promote the quality of care. The US Centers for Medicare and Medicaid Services have used Patient Safety Indicator 90 (PSI90), a composite rate of hospital-acquired conditions (HACs), to adjust payments and score hospitals on quality since 2015. However, PSI90 may be associated with adverse prioritization for preventing some conditions over others.Our objective was to evaluate the time-dependent rates of HACs between 2013 and 2016 to assess the association of funding models on adverse events, particularly pressure injury. METHODS:We analyzed a retrospective observational cohort of patients hospitalized in US Academic Medical Centers observed by the Vizient CDB/RM pre-post PSI90 implementation. Changes in HAC component rates of PSI90 between 2013 and 2016 were measured longitudinally using mixed-effects negative binomial regression modeling. RESULTS:Regardless of whether the composite measure of patient outcomes was PSI90 or all HACs, in general, there was significant decrease after PSI90 was implemented, reflecting an association between PSI90 and CMS reimbursement policy. However, pressure injury rates increased by 29.4% (SE = 0.08; P < 0.05) during this time frame, the only HAC observed to increase related to PSI90. CONCLUSIONS:Patient safety in hospitals will only thoroughly improve when hospitals are fully incentivized to practice prevention of all HACs rather than work around the harms that result from failed prevention efforts.
dc.format	Print
dc.language	eng
dc.publisher	LIPPINCOTT WILLIAMS & WILKINS
dc.relation.ispartof	Journal of patient safety
dc.relation.isbasedon	10.1097/pts.0000000000000517
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1117 Public Health and Health Services
dc.subject.classification	Health Policy & Services
dc.title	Adverse Effects of the Medicare PSI-90 Hospital Penalty System on Revenue-Neutral Hospital-Acquired Conditions.
dc.type	Journal Article
utslib.citation.volume	16
utslib.location.activity	United States
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	open_access	*
pubs.consider-herdc	false
dc.date.updated	2020-10-01T23:26:19Z
pubs.issue	2
pubs.publication-status	Published
pubs.volume	16
utslib.citation.issue	2

Abstract:

OBJECTIVE:Health systems are grappling with improving the quality and safety of health care. By setting clear expectations, there is an opportunity to configure care models to decrease the risk of adverse events and promote the quality of care. The US Centers for Medicare and Medicaid Services have used Patient Safety Indicator 90 (PSI90), a composite rate of hospital-acquired conditions (HACs), to adjust payments and score hospitals on quality since 2015. However, PSI90 may be associated with adverse prioritization for preventing some conditions over others.Our objective was to evaluate the time-dependent rates of HACs between 2013 and 2016 to assess the association of funding models on adverse events, particularly pressure injury. METHODS:We analyzed a retrospective observational cohort of patients hospitalized in US Academic Medical Centers observed by the Vizient CDB/RM pre-post PSI90 implementation. Changes in HAC component rates of PSI90 between 2013 and 2016 were measured longitudinally using mixed-effects negative binomial regression modeling. RESULTS:Regardless of whether the composite measure of patient outcomes was PSI90 or all HACs, in general, there was significant decrease after PSI90 was implemented, reflecting an association between PSI90 and CMS reimbursement policy. However, pressure injury rates increased by 29.4% (SE = 0.08; P < 0.05) during this time frame, the only HAC observed to increase related to PSI90. CONCLUSIONS:Patient safety in hospitals will only thoroughly improve when hospitals are fully incentivized to practice prevention of all HACs rather than work around the harms that result from failed prevention efforts.

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http://hdl.handle.net/10453/142988