Surgical Site Infection Prevention in 2018 and Beyond

The majority of states in this country now have laws or regulations requiring public reporting of HAIs.2 For almost a decade, the care necessitated to treat many of these infections has not been reimbursed by the Centers for Medicare & Medicaid Services. A different approach has been adopted by private insurers with payforperformance or valuebased purchasing programs. Both types of programs are designed to incentivize safer care, either with financial rewards for meeting certain performance measures or with penalties for poor outcomes, such as HAIs.3 At the same time, a variety of national collaborative infection prevention (IP) initiatives have been undertaken. Unfortunately, many of the proposed practice improvements in the IP initiatives are often ineffective in producing improved outcomes because they are not executed well or sustainable (eg, staff member hand hygiene compliance).4 In addition, the payforperformance and valuebased purchasing programs are not consistently effective. Authors from the Harvard and Stanford University Business Schools have reported that the penalties have had a negative effect by increasing the incidence of hospital upcoding, possibly unintentionally (ie, a provider bills a health insurance payer using a Current Procedural Terminology [CPT] code for a more expensive service than was performed) to collect greater reimbursement.5