To the Editor The effectiveness of Centers for Medicare & Medicaid Services (CMS) performance-based payment strategies will shape efforts to improve the quality and value of care. Waters et al1 examined the effect of the Hospital-Acquired Conditions (HACs) Initiative, which denies incremental payment for 8 complications on 4 outcomes: central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure ulcers (HAPUs), and injurious inpatient falls. They found an association with reductions in CLABSIs and CAUTIs but not injurious falls or stage III/IV HAPUs. Waters et al concluded that there is less evidence that changing hospital processes affects these other 2 outcomes, but we believe this conclusion may be missing key factors.
Joanne Spetz, Diane S. Brown, Carolyn S. Aydin. Ongoing Attention to Injurious Inpatient Falls and Pressure Ulcers. JAMA Intern Med. 2015;175(9):1580–1581. doi:10.1001/jamainternmed.2015.2549