--- title: "CMS changes in reimbursement for HAIs: setting a research agenda | Sutter Health" description: "To outline a research agenda on the impact of CMS's payment policy on the healthcare system and the prevention of healthcare-associated infections." url: "https://www.sutterhealth.org/research/publications/cms-changes-in-reimbursement-for-hais-1055312566" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. CMS changes in reimbursement for HAIs: setting a research agenda # CMS changes in reimbursement for HAIs: setting a research agenda Stone PW, Glied SA, McNair PD, Matthes N, Cohen B, Landers TF, & Larson EL. _Med Care. 48(5):433-9. doi: 10.1097/MLR.0b013e3181d5fb3f._ 2010-05-01 ## Abstract #### BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) promulgated regulations commencing October 1, 2008, which deny payment for selected conditions occurring during the hospital stay and are not present on admission. Three of the 10 hospital-acquired conditions covered by the new CMS policy involve healthcare-associated infections, which are a common, expensive, and often preventable cause of inpatient morbidity and mortality. #### OBJECTIVE: To outline a research agenda on the impact of CMS's payment policy on the healthcare system and the prevention of healthcare-associated infections. #### METHODS: An invitational day-long conference was convened in April 2009. Including the planning committee and speakers there were 41 conference participants who were national experts and senior researchers. #### RESULTS: Building upon a behavioral model and organizational theory and management research a conceptual framework was applied to organize the wide range of issues that arose. A broad array of research topics was identified. Thirty-two research agenda items were organized in the areas of incentives, environmental factors, organizational factors, clinical outcomes, staff outcomes, and financial outcomes. Methodological challenges are also discussed. #### CONCLUSIONS: This policy is a first significant step to move output-based inpatient funding to outcome-based funding, and this agenda is applicable to all hospital-acquired conditions. Studies beginning soon will have the best hope of capturing data for the years preceding the policy change, a key element in non-experimental research. The CMS payment policy offers an excellent opportunity to understand and influence the use of financial incentives for improving patient safety. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/20351584) ## Research topics - [Health Policy](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Policy%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [From small area variations to accountable care organizations: how health services research can inform policy](https://www.sutterhealth.org/research/publications/small-variations-to-accountable-care-organizations-1055312595) Luft HS. Annu Rev Public Health. 33:377-92. doi: 10.1146/annurev-publhealth-031811-124701. Epub 2012 Jan 3. 2012 Apr 01 - Publication ### [Three political realities in expanding coverage for the working poor: one state's experience.](https://www.sutterhealth.org/research/publications/expand-coverage-wking-poor-one-state-1055312625) Kinney ED, Tai-Seale M, Greene JY, Murray R, Tierney W. Health Aff (Millwood). 18(4):188-92. 1999 Jul 01 - Publication ### [Enhancing Medicare's hospital-acquired conditions policy to encompass readmissions.](https://www.sutterhealth.org/research/publications/medicare-hosp-acquired-conds-policy-readmissions-1055312903) McNair PD, Luft HS. Medicare Medicaid Res Rev. 2012 Jun 1;2(2). pii: mmrr.002.02.a03. doi: 10.5600/mmrr.002.02.a03. eCollection 2012. 2012 Jun 01 - Publication ### [Capacity building for assessing new technologies: approaches to examining personalized medicine in practice.](https://www.sutterhealth.org/research/publications/capacity-building-for-assessing-new-technologies-1055312563) Van Bebber SL, Trosman JR, Liang SY, Wang G, Marshall DA, Knight S, Phillips KA. Per Med. 7(4):427-439 2010 Jul 01 - Publication ### [The effect of report cards on consumer choice in the health insurance market.](https://www.sutterhealth.org/research/publications/report-card-effect-consumer-health-insur-choice-1055312552) Wedig GJ, Tai-Seale M. J Health Econ. 21(6):1031-48. 2002 Nov 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/cms-changes-in-reimbursement-for-hais-1055312566#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"CMS changes in reimbursement for HAIs: setting a research agenda"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/cms-changes-in-reimbursement-for-hais-1055312566#medicalscholarlyarticle","name":"CMS changes in reimbursement for HAIs: setting a research agenda","headline":"CMS changes in reimbursement for HAIs: setting a research agenda","abstract":"BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) promulgated regulations commencing October 1, 2008, which deny payment for selected conditions occurring during the hospital stay and are not present on admission. Three of the 10 hospital-acquired conditions covered by the new CMS policy involve healthcare-associated infections, which are a common, expensive, and often preventable cause of inpatient morbidity and mortality. OBJECTIVE: To outline a research agenda on the impact of CMS's payment policy on the healthcare system and the prevention of healthcare-associated infections. METHODS: An invitational day-long conference was convened in April 2009. Including the planning committee and speakers there were 41 conference participants who were national experts and senior researchers. RESULTS: Building upon a behavioral model and organizational theory and management research a conceptual framework was applied to organize the wide range of issues that arose. A broad array of research topics was identified. Thirty-two research agenda items were organized in the areas of incentives, environmental factors, organizational factors, clinical outcomes, staff outcomes, and financial outcomes. Methodological challenges are also discussed. CONCLUSIONS: This policy is a first significant step to move output-based inpatient funding to outcome-based funding, and this agenda is applicable to all hospital-acquired conditions. Studies beginning soon will have the best hope of capturing data for the years preceding the policy change, a key element in non-experimental research. 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