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Centers for medicare and medicaid services hospital-acquired conditions policy for central line-associated bloodstream infection (CLABSI) and cather-associated urinary tract infection (CAUTI) shows minimal impact on hospital reimbursement

Published online by Cambridge University Press:  28 June 2018

Michael S. Calderwood ,
Alison Tse Kawai ,
Robert Jin  and
Grace M. Lee
Michael S. Calderwood*
Affiliation:
Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Alison Tse Kawai
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Robert Jin
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
Grace M. Lee
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts Department of Pediatrics, Stanford University School of Medicine, Stanford, California
*
Author for correspondence: Michael S. Calderwood, MD, MPH, Section of Infectious Disease and International Health, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Suite 5C, Lebanon, NH 03756. E-mail: Michael.S.Calderwood@hitchcock.org
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Abstract

Objective

In 2008, the Centers for Medicare and Medicaid Services (CMS) stopped reimbursing for hospital-acquired conditions (HACs) not present on admission (POA). We sought to understand why this policy did not impact central line–associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) trends.

Design

Retrospective cohort study.

Setting

Acute-care hospitals in the United States.

Participants

Fee-for-service Medicare patients discharged January 1, 2007, through December 31, 2011.

Methods

Using inpatient Medicare claims data, we analyzed billing practices before and after the HAC policy was implemented, including the use and POA designation of codes for CLABSI or CAUTI. For the 3-year period following policy implementation, we determined the impact on diagnosis-related groups (DRG) determining reimbursement as well as hospital characteristics associated with the reimbursement impact.

Results

During the study period, 65,205,607 Medicare fee-for-service hospitalizations occurred at 3,291 acute-care, nonfederal US hospitals. Based on coding, CLABSI and CAUTI affected 0.23% and 0.06% of these hospitalizations, respectively. In addition, following the HAC policy, 82% of the CLABSI codes and 91% of the CAUTI codes were marked POA, which represented a large increase in the use of this designation. Finally, for the small numbers of CLABSI and CAUTI coded as not POA, financial impacts were detected on only 0.4% of the hospitalizations with a CLABSI code and 5.7% with a CAUTI code.

Conclusions

Part of the reason the HAC policy did not have its intended impact is that billing codes for CLABSI and CAUTI were rarely used, were commonly listed as POA in the postpolicy period, and infrequently impacted hospital reimbursement.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 8 , August 2018 , pp. 897 - 901
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

1. Centers for Medicare and Medicaid Services; Department of Health and Human Services. Medicare program: changes to the hospital inpatient prospective payment systems and fiscal year. 2008 rates. Fed Regist 2007;72:47379–47428.Google Scholar
2. Acute inpatient PPS. Centers for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteinpatientPPS/index.html. Updated 2017. Accessed February 21, 2018.Google Scholar
3. Nguyen, OK, Halm, EA, Makam, AN. Relationship between hospital financial performance and publicly reported outcomes. J Hosp Med 2016;11:481–488.Google Scholar
4. Lee, GM, Kleinman, K, Soumerai, SB, et al. Effect of nonpayment for preventable infections in US hospitals. N Engl J Med 2012;367:1428–1437.Google Scholar
5. McHugh, M, Van Dyke, K, Osei-Anto, A, Haque, A. Medicare’s payment policy for hospital-acquired conditions: perspectives of administrators from safety net hospitals. Med Care Res Rev 2011;68:667–682.Google Scholar
6. Lee, GM, Hartmann, CW, Graham, D, et al. Perceived impact of the Medicare policy to adjust payment for healthcare-associated infections. Am J Infect Control 2012;40:314–319.Google Scholar
7. McNutt, R, Johnson, TJ, Odwanzy, R, et al. Change in MS-DRG assignment and hospital reimbursement as a result of Centers for Medicare & Medicaid changes in payment for hospital-acquired conditions: is it coding or quality? Qual Manag Health Care 2010;19:17–24.Google Scholar
8. Department of Health and Human Services. Centers for Medicare and Medicaid Services. Hospital-Acquired Conditions and Present on Admission Indicator Reporting Provision. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/wPOA-Fact-Sheet.pdf. Published 2017. Accessed February 21, 2018.Google Scholar
9. National Technical Information Service, United States Department of Commerce. CMS Medicare Severity Diagnosis Related Groups (MS-DRG) Grouper. https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2011101128.xhtml. Accessed February 21, 2018.Google Scholar
10. American Hospital Association. Annual Survey Database. http://www.ahadataviewer.com/book-cd-products/aha-survey. Updated 2018. Accessed February 21, 2018.Google Scholar
11. The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention. Centers for Disease Control and Prevention website. https://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf. Accessed May 3, 2018.Google Scholar
12. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of healthcare-associated infections. N Engl J Med 2014;370:1198–1208.Google Scholar
13. Healthcare Cost and Utilization Project: Costs for Hospital Stays in the United States, 2012. Agency for Healthcare Research and Quality website. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb181-Hospital-Costs-United-States-2012.pdf. Published 2012. Accessed May 3, 2018.Google Scholar
14. Meddings, JA, Reichert, H, Rogers, MA, Saint, S, Stephansky, J, McMahon, LF. Effect of nonpayment for hospital-acquired, catheter-associated urinary tract infection: a statewide analysis. Ann Intern Med 2012;157:305–312.Google Scholar
15. Meddings, J, Saint, S, McMcMahon, LR Jr. Hospital-acquired catheter-associated infection: documentation and coding issues may reduce financial impact of Medicare’s new payment policy. Infect Control Hosp Epidemiol 2010;31:627–633.Google Scholar
16. McNutt, R, Johnson, TJ, Odwazny, R, et al. Change in MS-DRG assignment and hospital reimbursement as a result of Centers for Medicare & Medicaid changes in payment for hospital-acquired conditions: is it coding or quality? Qual Manag Health Care 2010;19:17–24.Google Scholar
17. Schuller, K, Probst, J, Hardin, J, Bennett, K, Martin, A. Initial impact of Medicare’s nonpayment policy on catheter-associated urinary tract infections by hospital characteristics. Health Policy 2014;115:165–171.Google Scholar
18. Moehring, RW, Staheli, R, Miller, BA, Chen, LF, Sexton, DJ, Anderson, DJ. Central line-associated infections as defined by the Centers for Medicare and Medicaid Services’ Hospital-acquired condition versus standard infection control surveillance: why hospital compare seems conflicted. Infect Control Hosp Epidemiol 2013;34:238–244.Google Scholar
19. Johnson, T, Kane, JM, Odwazny, R, McNutt, R. Association of the position of a hospital-acquired condition diagnosis code with changes in Medicare severity diagnosis-related group assignment. J Hosp Med 2014;9:707–713.Google Scholar
20. Hospital-Acquired Condition Reduction Program. Centers for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/HAC-Reduction-Program.html. Updated 2017. Accessed February 21, 2018.Google Scholar
21. National Healthcare Safety Network. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/index.html. Updated 2017. Accessed February 21, 2018.Google Scholar