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Effect of Medicare’s Nonpayment Policy on Surgical Site Infections Following Orthopedic Procedures

Published online by Cambridge University Press:  10 May 2017

Jereen Z. Kwong ,
Yingjie Weng ,
Micaela Finnegan ,
Robyn Schaffer ,
Austin Remington ,
Catherine Curtin ,
Kathryn M. McDonald ,
Jay Bhattacharya  and
Tina Hernandez-Boussard
Jereen Z. Kwong
Affiliation:
Stanford School of Medicine, Stanford University, Stanford, California
Yingjie Weng
Affiliation:
Department of Surgery, Stanford School of Medicine, Stanford University, Stanford, California
Micaela Finnegan
Affiliation:
Stanford School of Medicine, Stanford University, Stanford, California
Robyn Schaffer
Affiliation:
Stanford School of Medicine, Stanford University, Stanford, California
Austin Remington
Affiliation:
Stanford School of Medicine, Stanford University, Stanford, California
Catherine Curtin
Affiliation:
Department of Surgery, Stanford School of Medicine, Stanford University, Stanford, California
Kathryn M. McDonald
Affiliation:
Stanford University Center for Health Policy, Stanford, California
Jay Bhattacharya
Affiliation:
Stanford University Center for Health Policy, Stanford, California
Tina Hernandez-Boussard*
Affiliation:
Department of Surgery, Stanford School of Medicine, Stanford University, Stanford, California Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, California
*
Address correspondence to Tina Hernandez-Boussard, Department of Medicine (Biomedical Informatics), Stanford School of Medicine, 1265 Welch Road, Stanford, CA 94305-5479 (boussard@stanford.edu).
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Abstract

OBJECTIVE

Orthopedic procedures are an important focus in efforts to reduce surgical site infections (SSIs). In 2008, the Centers for Medicare and Medicaid (CMS) stopped reimbursements for additional charges associated with serious hospital-acquired conditions, including SSI following certain orthopedic procedures. We aimed to evaluate the CMS policy’s effect on rates of targeted orthopedic SSIs among the Medicare population.

DESIGN

We examined SSI rates following orthopedic procedures among the Medicare population before and after policy implementation compared to a similarly aged control group. Using the Nationwide Inpatient Sample database for 2000–2013, we estimated rate ratios (RRs) of orthopedic SSIs among Medicare and non-Medicare patients using a difference-in-differences approach.

RESULTS

Following policy implementation, SSIs significantly decreased among both the Medicare and non-Medicare populations (RR, 0.7; 95% confidence interval [CI], 0.6–0.8) and RR, 0.8l; 95% CI, 0.7–0.9), respectively. However, the estimated decrease among the Medicare population was not significantly greater than the decrease among the control population (RR, 0.9; 95% CI, 0.8–1.1).

CONCLUSIONS

While SSI rates decreased significantly following the implementation of the CMS nonpayment policy, this trend was not associated with policy intervention but rather larger secular trends that likely contributed to decreasing SSI rates over time.

Infect Control Hosp Epidemiol 2017;38:817–822

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 7 , July 2017 , pp. 817 - 822
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. This work was presented at the 2016 Academy Health Annual Research Meeting, Boston, Massachusetts, on June 25, 2016.

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