APIC Applauds CMS Payment Restrictions on Certain Infections

Beginning Oct. 1, the Centers for Medicare and Medicaid Services (CMS) will no longer reimburse hospitals for costs related to three infections acquired during a hospital stay: catheter-associated urinary tract infections (UTIs), catheter-associated blood stream infections, and mediastinitis (a deep infection following coronary artery bypass surgery). Last week, CMS announced that surgical site infections following certain orthopedic procedures and bariatric surgery for obesity also will be added to the list of conditions for non-payment. According to Kathy Warye, CEO of the Association for Professionals in Infection Control and Epidemiology (APIC), these new payment restrictions are a good thing.

“We are pleased that CMS took the comments of infection preventionists into consideration when drafting the new regulations," Warye said. "We appreciate that the agency based [its] decision to add new conditions on whether they could be considered reasonably preventable through application of evidence-based guidelines."

Warye said the association supports tying payment to conditions that have a high prevention rate and associated actionable evidence-based prevention guidelines. "We stand ready to assist CMS with a value-based purchasing approach that recognizes not only the preventability of the condition, but also the institution’s track record in improving outcomes," she said. "We favor a balanced approach for payment that recognizes institutions that are making progress in reducing infections, rather than an all-or-nothing system based solely on non-payment for infections deemed preventable and welcome continued discussions on this topic."

The new regulations are in line with APIC's Targeting Zero initiative, which encourages all health care institutions to eliminate hospital-acquired infections, Warye added. “APIC applauds CMS for bringing much needed attention to the critical issue of HAIs," she said. "The new regulations, which will limit payment for preventable hospital-acquired conditions, have catapulted the issue of infection prevention into the limelight. We hope that this increased attention will drive compliance with evidence-based interventions to reduce these infections. While not all infections are preventable, working toward zero should be the goal."

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    May 2021


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