Jennifer A. Meddings, MD, MSc; Heidi Reichert, MA; Mary A.M. Rogers, PhD, MS; Sanjay Saint, MD, MPH; Joe Stephansky, PhD; Laurence F. McMahon Jr., MD, MPH
Presented in part at the Society for Healthcare Epidemiology of America Fifth Decennial International Conference on Healthcare-Associated Infections, Atlanta, Georgia, 18–22 March 2010; the Society of General Internal Medicine 33rd Annual Meeting, Minneapolis, Minnesota, 28 April–1 May 2010; and the AcademyHealth 2010 Annual Research Meeting, Boston, Massachusetts, 27–29 June 2010.
Acknowledgment: The authors appreciate the insight provided by Gwendolyn Blackford, BS, about processes used and regulations followed by hospital coders while assigning diagnosis codes. They also thank Jack Hughes, MD, for his helpful suggestions and 3M for making the MS Grouper Software available to assess changes in hospital payment. The authors thank Andrew Hickner, MSI, for providing assistance with references and manuscript editing and Casey Crimmins, CPA, BGS, with the University of Michigan Department of Finance for providing crucial information to calculate the example of financial impact for the University of Michigan.
Grant Support: The study was funded by grant 1452.11 from the Blue Cross Blue Shield of Michigan Foundation. The authors were also supported by awards 1R010HS018344-01A1 (Dr. McMahon) and 1K08-HS019767-01 (Dr. Meddings) from the Agency for Healthcare Research and Quality; award R21-DK078717 (Dr. Saint) from the National Institute of Diabetes and Digestive and Kidney Diseases; and award R01-NR010700 (Dr. Saint) from the National Institute of Nursing Research. Dr. Meddings is also a recipient of the National Institutes of Health Clinical Loan Repayment Program for 2009 to 2012.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-0716.
Reproducible Research Statement:Study protocol: Available from Dr. Meddings (e-mail, firstname.lastname@example.org). Data set: Available by application, purchase, and data use agreement from the Healthcare Cost and Utilization Project (www.hcup-us.ahrq.gov/databases.jsp). Statistical code: Not available.
Requests for Single Reprints: Jennifer Meddings, MD, MSc, Division of General Medicine, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI 48109-2800; e-mail, email@example.com.
Current Author Addresses: Drs. Meddings, Rogers, Saint, and McMahon and Ms. Reichert: Division of General Medicine, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI 48109-2800.
Dr. Stephansky: Michigan Health & Hospital Association, 110 West Michigan Avenue, Suite 1200, Lansing, MI 48933.
Author Contributions: Conception and design: J.A. Meddings, M.A.M. Rogers, S. Saint, L.F. McMahon.
Analysis and interpretation of the data: J.A. Meddings, H. Reichert, M.A.M. Rogers, J. Stephansky.
Drafting of the article: J.A. Meddings, H. Reichert.
Critical revision of the article for important intellectual content: J.A. Meddings, M.A.M. Rogers, S. Saint, J. Stephansky, L.F. McMahon.
Final approval of the article: J.A. Meddings, M.A.M. Rogers, S. Saint, J. Stephansky, L.F. McMahon.
Statistical expertise: J.A. Meddings, H. Reichert, M.A.M. Rogers.
Obtaining of funding: J.A. Meddings.
Administrative, technical, or logistic support: J.A. Meddings, J. Stephansky, L.F. McMahon.
Collection and assembly of data: J.A. Meddings, H. Reichert, J. Stephansky.
Most (59% to 86%) hospital-acquired urinary tract infections (UTIs) are catheter-associated urinary tract infections (CAUTIs). As of 2008, claims data are used to deny payment for certain hospital-acquired conditions, including CAUTIs, and publicly report hospital performance.
To examine rates of UTIs in adults that are coded in claims data as hospital-acquired and catheter-associated events and evaluate how often nonpayment for CAUTI lowers hospital payment.
Before-and-after study of all-payer cross-sectional claims data.
96 nonfederal acute care Michigan hospitals.
Nonobstetric adults discharged in 2007 (n = 767 531) and 2009 (n = 781 343).
Hospital rates of UTIs (categorized as catheter-associated or hospital-acquired) and frequency of reduced payment for hospital-acquired CAUTIs.
Hospitals frequently requested payment for non-CAUTIs as secondary diagnoses: 10.0% (95% CI, 9.5% to 10.5%) of discharges in 2007 and 10.3% (CI, 9.8% to 10.9%) in 2009. Hospital rates of CAUTI were very low: 0.09% (CI, 0.06% to 0.12%) in 2007 and 0.14% (CI, 0.11% to 0.17%) in 2009. In 2009, 2.6% (CI, 1.6% to 3.6%) of hospital-acquired UTIs were described as CAUTIs. Nonpayment for hospital-acquired CAUTIs reduced payment for 25 of 781 343 (0.003%) hospitalizations in 2009.
Data are from only 1 state and involved only 1 year before and after nonpayment for complications. Hospital prevention practices were not examined.
Catheter-associated UTI rates determined by claims data seem to be inaccurate and are much lower than expected from epidemiologic surveillance data. The financial impact of current nonpayment policy for hospital-acquired CAUTI is low. Claims data are currently not valid data sets for comparing hospital-acquired CAUTI rates for the purpose of public reporting or imposing financial incentives or penalties.
Blue Cross Blue Shield of Michigan Foundation.
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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. doi: 10.7326/0003-4819-157-5-201209040-00003
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Published: Ann Intern Med. 2012;157(5):305-312.
Healthcare Delivery and Policy, Hospital Medicine, Hospital-Acquired Infections, Infectious Disease.
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