Journal Article

Implementation of the Centers for Medicare & Medicaid Services' nonpayment policy for preventable hospital-acquired conditions in rural and nonrural US hospitals.

Bae S-H, Yoder LH. Journal of nursing care quality. 2015;30:313-22.

Since 2008, Medicare no longer pays hospitals for treating patients who develop preventable complications. Using data from the Hospital Compare program, this large cross-sectional study examined how this no pay for errors policy may affect rural hospitals differently than nonrural hospitals. The study looked at four nursing-sensitive adverse outcomes: pressure ulcers, falls with injuries, catheter-associated urinary tract infections, and vascular catheter–associated infections. Rural hospitals had significantly fewer of these hospital-acquired conditions, except for patient falls with injury. The lower rates in some of these conditions are likely related to rural hospitals generally seeing patients with lower acuity levels, whereas the authors speculate that the increased fall rate may be explained by lower levels of nurse staffing and skill level. A previous AHRQ WebM&M interview addressed the potential benefits and limitations of insurers not paying for preventable complications.