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Article
March 27, 1987

The Financial Incentive for Hospitals to Prevent Nosocomial Infections Under the Prospective Payment SystemAn Empirical Determination From a Nationally Representative Sample

Author Affiliations

From the Division of Epidemiology, Department of Internal Medicine, Southwestern Medical School, University of Texas Health Science Center at Dallas (Dr Haley); and the Hospital Infections Program, Center for Infectious Diseases, Centers for Disease Control, Atlanta (Drs White, Culver, and Hughes).

From the Division of Epidemiology, Department of Internal Medicine, Southwestern Medical School, University of Texas Health Science Center at Dallas (Dr Haley); and the Hospital Infections Program, Center for Infectious Diseases, Centers for Disease Control, Atlanta (Drs White, Culver, and Hughes).

JAMA. 1987;257(12):1611-1614. doi:10.1001/jama.1987.03390120073026
Abstract

To clarify the financial incentives for hospitals to prevent nosocomial infections, we analyzed 9423 nosocomial infections identified in 169526 admissions selected randomly from the adult admissions to a random sample of US hospitals. By classifying each admission into a baseline diagnosis related group (DRG) (after first excluding all diagnoses of nosocomial infection) and a final DRG (after including these diagnoses), we found that only 5% to 18% of nosocomial infections would have caused the admission to be reclassified to a higher-paying DRG, depending on the extent to which physicians recorded nosocomial infection diagnoses in patients' medical records. The extra payment from the reclassification, averaged over all nosocomial infections, would have been no more than $93 per infection (in 1985 reimbursement rates), constituting only 5% of the hospitals' costs for treating these infections. Thus, at least 95% of the cost savings obtained from preventing nosocomial infections represents financial gains to the hospital.

(JAMA 1987;257:1611-1614)

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